Healthcare Provider Details

I. General information

NPI: 1164776514
Provider Name (Legal Business Name): RJG COASTAL CHIROPRACTIC P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11964 BOYETTE RD
RIVERVIEW FL
33569-5601
US

IV. Provider business mailing address

11964 BOYETTE RD
RIVERVIEW FL
33569-5601
US

V. Phone/Fax

Practice location:
  • Phone: 813-540-7270
  • Fax: 813-671-9045
Mailing address:
  • Phone: 813-540-7270
  • Fax: 813-671-9045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 10579
License Number StateFL

VIII. Authorized Official

Name: RYAN JAMES GARCIA
Title or Position: PRESIDENT
Credential: DC
Phone: 813-540-7270