Provider Demographics
NPI:1588474100
Name:COASTAL CHIROPRACTIC
Entity type:Organization
Organization Name:COASTAL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-894-5474
Mailing Address - Street 1:4610 CENTRAL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-1008
Mailing Address - Country:US
Mailing Address - Phone:727-370-2056
Mailing Address - Fax:
Practice Address - Street 1:4610 CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1008
Practice Address - Country:US
Practice Address - Phone:727-370-2056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty