Provider Demographics
NPI:1124644943
Name:GULF COAST CLINIC OF CHIROPRACTIC LLC
Entity type:Organization
Organization Name:GULF COAST CLINIC OF CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-532-3160
Mailing Address - Street 1:2825 NASA PKWY
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-3215
Mailing Address - Country:US
Mailing Address - Phone:281-532-3160
Mailing Address - Fax:281-532-3480
Practice Address - Street 1:2825 NASA PKWY
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-3215
Practice Address - Country:US
Practice Address - Phone:281-532-3160
Practice Address - Fax:281-532-3480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty