Provider Demographics
NPI:1053655787
Name:COACHMAN CHIROPRACTIC INJURY AND WELLNESS
Entity Type:Organization
Organization Name:COACHMAN CHIROPRACTIC INJURY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-940-3729
Mailing Address - Street 1:2435 US HIGHWAY 19
Mailing Address - Street 2:101
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-3903
Mailing Address - Country:US
Mailing Address - Phone:727-940-3729
Mailing Address - Fax:727-940-5258
Practice Address - Street 1:2424 SUNSET POINT RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1513
Practice Address - Country:US
Practice Address - Phone:727-799-4608
Practice Address - Fax:727-799-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty