MEDICARE: COASTAL CHIROPRACTIC OF MUSKEGON PC

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	2301010234	MI

General Provider Information

NPI Number	:	1295229631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL CHIROPRACTIC OF MUSKEGON PC

Provider Business Mailing Address
First Line	:	994 W BROADWAY AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49441-3522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	994 W BROADWAY AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49441-3522
Country	:	US
Telephone Number	:	231-755-3333
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL HAUTAMAKI
Credential	:	DC
Telephone Number	:	231-755-3333

Provider Enumeration Date	:	06/19/2018
Last Update Date	:	06/19/2018

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