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General NPI Number Information
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NPI Number | 1548641079
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Entity Type | Organization
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Legal Business Name | COASTAL CHIROPRACTIC CARE LLC
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Dates
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Enumeration Date | 06/10/2015
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Last Update Date | 06/16/2015
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Provider Practice Location Address
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Address Line | 1539 HIGHWAY 17
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City | LITTLE RIVER
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State | SC
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Zip | 29566-9224
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Country | US
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Telephone | 910-308-8150
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 MONTICELLO DR
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-8100
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Country | US
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Telephone | 910-308-8150
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. JARED HAYES
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Credential | D.C.
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Telephone | 910-308-8150
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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 | 3815
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License Number State | SC
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