Provider Demographics
NPI:1285779272
Name:COASTAL CHIROPRACTIC PLC
Entity type:Organization
Organization Name:COASTAL CHIROPRACTIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-627-2700
Mailing Address - Street 1:119 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-2224
Mailing Address - Country:US
Mailing Address - Phone:757-627-2700
Mailing Address - Fax:757-627-2709
Practice Address - Street 1:119 W 21ST ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2224
Practice Address - Country:US
Practice Address - Phone:757-627-2700
Practice Address - Fax:757-627-2709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty