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General NPI Number Information
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NPI Number | 1053655787
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Entity Type | Organization
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Legal Business Name | COACHMAN CHIROPRACTIC INJURY AND WELLNESS
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 11/19/2012
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Provider Practice Location Address
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Address Line | 2424 SUNSET POINT RD
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City | CLEARWATER
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State | FL
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Zip | 33765-1513
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Country | US
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Telephone | 727-799-4608
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Fax | 727-799-9102
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Provider Business Mailing Address
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Address Line | 2435 US HIGHWAY 19 101
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City | HOLIDAY
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State | FL
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Zip | 34691-3903
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Country | US
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Telephone | 727-940-3729
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Fax | 727-940-5258
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT LEWIS GOLD
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Credential | DC
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Telephone | 727-940-3729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH9725
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License Number State | FL
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