=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205992179
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COFLIN CHIROPRACTIC GROUP,INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2006
-----------------------------------------------------
Last Update Date | 02/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5444 CLAYTON RD SUITE B
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94521-4099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-672-6500
-----------------------------------------------------
Fax | 925-672-6502
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1271 SHELL CIRCLE
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94517-1222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-580-4321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DANIEL L. COFLIN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 925-580-4321
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC28050
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------