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General NPI Number Information
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NPI Number | 1215701826
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Entity Type | Organization
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Legal Business Name | COASTAL HEALTH AND WELLNESS JAX LLC
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Dates
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Enumeration Date | 11/14/2023
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 440 THIRD ST. SUITE A
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City | NEPTUNE BEACH FLORIDA
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State | FL
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Zip | 32266
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Country | US
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Telephone | 904-249-5999
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Fax | 904-249-1768
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Provider Business Mailing Address
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Address Line | 440 3RD ST STE A
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City | NEPTUNE BEACH
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State | FL
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Zip | 32266-5146
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Country | US
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Telephone | 904-249-5999
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. SUSAN SHEPLER
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Credential | DC
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Telephone | 904-249-5999
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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 |
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License Number State |
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