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General NPI Number Information
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NPI Number | 1093892473
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Entity Type | Organization
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Legal Business Name | COASTAL CHIROPRACTIC PA
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 2323 NE 26TH AVE SUITE 109
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City | POMPANO BEACH
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State | FL
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Zip | 33062-1147
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Country | US
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Telephone | 954-946-3703
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Fax | 954-943-2280
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Provider Business Mailing Address
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Address Line | 2323 NE 26TH AVE SUITE 109
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City | POMPANO BEACH
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State | FL
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Zip | 33062-1147
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Country | US
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Telephone | 954-946-3703
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Fax | 954-943-2280
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Authorized Official
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Title or Position | OFFICER
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Name | DR. GENE A PERKINS
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Credential | D C
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Telephone | 954-946-3703
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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 | CH0007854
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License Number State | FL
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