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General NPI Number Information
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NPI Number | 1518319821
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Entity Type | Organization
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Legal Business Name | COASTAL CHIROPRACTIC TAMPA BAY LLC
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Dates
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Enumeration Date | 07/11/2016
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Last Update Date | 07/11/2016
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Provider Practice Location Address
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Address Line | 2194 MAIN ST STE G
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City | DUNEDIN
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State | FL
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Zip | 34698-5656
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Country | US
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Telephone | 352-650-3756
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Fax |
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Provider Business Mailing Address
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Address Line | 2194 MAIN ST STE G
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City | DUNEDIN
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State | FL
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Zip | 34698-5656
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Country | US
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Telephone | 727-733-1601
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DREW KYCYNKA
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Credential | DC
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Telephone | 727-733-1601
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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 | CH6488
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License Number State | FL
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