Healthcare Provider Details

I. General information

NPI: 1447284815
Provider Name (Legal Business Name): MICHAEL EDWARD COGGINS JR. DC, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 VALLEY MEADOW DR
OAK VIEW CA
93022-9562
US

IV. Provider business mailing address

PO BOX 154
OAK VIEW CA
93022-0154
US

V. Phone/Fax

Practice location:
  • Phone: 805-415-3228
  • Fax:
Mailing address:
  • Phone: 805-415-3228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC24318
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: