MEDICARE: GOLD COAST CHIROPRACTIC CENTER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH6359	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447212253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLD COAST CHIROPRACTIC CENTER PA

Provider Business Mailing Address
First Line	:	1000 LINTON BLVD
Second Line	:	SUITE A7
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-1123
Country	:	US
Telephone Number	:	561-272-0388
Fax Number	:	561-272-0498

Provider Business Practice Location Address
First Line	:	1000 LINTON BLVD
Second Line	:	SUITE A7
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-1123
Country	:	US
Telephone Number	:	561-272-0388
Fax Number	:	561-272-0498

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DOUGLAS MANOLAKOS
Credential	:	DC
Telephone Number	:	561-272-0388

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	03/21/2012

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