Provider Demographics
NPI:1104100593
Name:COASTAL CHIROPRACTIC HEALTH SOLUTIONS PLLC
Entity type:Organization
Organization Name:COASTAL CHIROPRACTIC HEALTH SOLUTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-390-0607
Mailing Address - Street 1:9200 BONITA BEACH RD SE STE 203
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4278
Mailing Address - Country:US
Mailing Address - Phone:239-390-0607
Mailing Address - Fax:239-390-0601
Practice Address - Street 1:9200 BONITA BEACH RD SE STE 203
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4278
Practice Address - Country:US
Practice Address - Phone:239-390-0607
Practice Address - Fax:239-390-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty