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General NPI Number Information
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NPI Number | 1972045995
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Entity Type | Organization
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Legal Business Name | COASTAL CHIROPRACTIC AND ACUPUNCTURE LLC
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Dates
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Enumeration Date | 11/08/2016
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 2130 BOURBON ST
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City | FOLEY
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State | AL
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Zip | 36535-2463
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Country | US
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Telephone | 740-808-2779
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Fax |
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Provider Business Mailing Address
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Address Line | 2130 BOURBON ST
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City | FOLEY
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State | AL
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Zip | 36535-2463
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Country | US
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Telephone | 740-808-2779
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. TODD BRIAN WALTERS
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Credential | DC
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Telephone | 740-808-2779
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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 | 2478
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License Number State | AL
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