Healthcare Provider Details

I. General information

NPI: 1750058889
Provider Name (Legal Business Name): COASTLINE SPINE CHIROPRACTIC & REHAB, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 01/11/2025
Certification Date: 01/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 STATE ROAD 16 STE 2
ST AUGUSTINE FL
32084-6567
US

IV. Provider business mailing address

900 STATE ROAD 16 STE 2
ST AUGUSTINE FL
32084-6567
US

V. Phone/Fax

Practice location:
  • Phone: 904-599-7791
  • Fax:
Mailing address:
  • Phone: 904-599-7791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM BEASLEY
Title or Position: OWNER
Credential: D.C.
Phone: 904-599-7791