Provider Demographics
NPI:1992160816
Name:COASTAL CHIROPRACTIC AND ACUPUNCTURE
Entity type:Organization
Organization Name:COASTAL CHIROPRACTIC AND ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC, L AC
Authorized Official - Phone:609-748-8779
Mailing Address - Street 1:106 E JIMMIE LEEDS RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9508
Mailing Address - Country:US
Mailing Address - Phone:609-748-8779
Mailing Address - Fax:609-652-6687
Practice Address - Street 1:106 E JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9508
Practice Address - Country:US
Practice Address - Phone:609-748-8779
Practice Address - Fax:609-652-6687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00600700111N00000X
NJ25MZ00032700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty