MEDICARE: COASTAL CHIROPRACTIC HEALTH SOLUTIONS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1104100593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL CHIROPRACTIC HEALTH SOLUTIONS PLLC

Provider Business Mailing Address
First Line	:	9200 BONITA BEACH RD SE STE 203
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-4278
Country	:	US
Telephone Number	:	239-390-0607
Fax Number	:	239-390-0601

Provider Business Practice Location Address
First Line	:	9200 BONITA BEACH RD SE STE 203
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-4278
Country	:	US
Telephone Number	:	239-390-0607
Fax Number	:	239-390-0601

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MARIA D OTERO
Credential	:
Telephone Number	:	239-390-0607

Provider Enumeration Date	:	10/04/2011
Last Update Date	:	09/28/2020

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