MEDICARE: COAST CHIROPRACTIC CENTERS, 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	111NX0800X	Orthopedic Chiropractor	CH 9690	FL

General Provider Information

NPI Number	:	1669740932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COAST CHIROPRACTIC CENTERS, INC.

Provider Business Mailing Address
First Line	:	7270 COLLEGE PKWY STE 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-5658
Country	:	US
Telephone Number	:	239-278-3344
Fax Number	:	239-278-3159

Provider Business Practice Location Address
First Line	:	7270 COLLEGE PKWY STE 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-5658
Country	:	US
Telephone Number	:	239-278-3344
Fax Number	:	239-278-3159

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIAN TIMOTHY HARCOURT
Credential	:	D.C.
Telephone Number	:	239-278-3344

Provider Enumeration Date	:	12/01/2011
Last Update Date	:	12/07/2011

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