Provider Demographics
NPI:1932689833
Name:BEACH CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:BEACH CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-258-1661
Mailing Address - Street 1:3000 N ATLANTIC AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-5060
Mailing Address - Country:US
Mailing Address - Phone:321-868-2225
Mailing Address - Fax:
Practice Address - Street 1:3000 N ATLANTIC AVE STE 105
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-5060
Practice Address - Country:US
Practice Address - Phone:321-868-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty