MEDICARE: COASTAL CHIROPRACTIC PLC

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	:	1285779272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL CHIROPRACTIC PLC

Provider Business Mailing Address
First Line	:	119 W 21ST ST
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23517-2224
Country	:	US
Telephone Number	:	757-627-2700
Fax Number	:	757-627-2709

Provider Business Practice Location Address
First Line	:	119 W 21ST ST
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23517-2224
Country	:	US
Telephone Number	:	757-627-2700
Fax Number	:	757-627-2709

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. MARK HAYNES
Credential	:	D.C.
Telephone Number	:	757-627-2700

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	08/22/2020

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Directions to “COASTAL CHIROPRACTIC PLC ” Practice Location

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