MEDICARE: GOLD COAST PHYSICIANS CENTER INC

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	CH7758	FL

General Provider Information

NPI Number	:	1114168457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLD COAST PHYSICIANS CENTER INC

Provider Business Mailing Address
First Line	:	1501 PRESIDENTIAL WAY
Second Line	:	SUITE 19
City	:	WEST PALM BCH
State	:	FL
Zip	:	33401-1800
Country	:	US
Telephone Number	:	561-686-3201
Fax Number	:	561-686-1622

Provider Business Practice Location Address
First Line	:	601 N CONGRESS AVE
Second Line	:	SUITE # 410
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-4703
Country	:	US
Telephone Number	:	561-686-3201
Fax Number	:	651-686-1622

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. KAREN A RADFORD
Credential	:
Telephone Number	:	561-380-0477

Provider Enumeration Date	:	03/17/2009
Last Update Date	:	04/28/2014

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