Provider Demographics
NPI:1144409277
Name:GULF COAST CHIROPRACTIC
Entity Type:Organization
Organization Name:GULF COAST CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MONTALBANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-899-2300
Mailing Address - Street 1:2855 EASTEX FWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3065
Mailing Address - Country:US
Mailing Address - Phone:409-899-2300
Mailing Address - Fax:409-898-2273
Practice Address - Street 1:2855 EASTEX FWY
Practice Address - Street 2:SUITE E
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3065
Practice Address - Country:US
Practice Address - Phone:409-899-2300
Practice Address - Fax:409-898-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT20051OtherUPIN
TX8120051OtherBLUE LINK
TX120013101Medicaid
TX80V913OtherBLUE CROSS BLUE SHIELD
TX00L03BMedicare PIN