Provider Demographics
NPI:1255508198
Name:COASTAL HEALING
Entity Type:Organization
Organization Name:COASTAL HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:BARAN
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-790-5315
Mailing Address - Street 1:115 WYNDHAM WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-6710
Mailing Address - Country:US
Mailing Address - Phone:910-790-5315
Mailing Address - Fax:910-790-5316
Practice Address - Street 1:122 N CARDINAL DR
Practice Address - Street 2:UNIT 106
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3803
Practice Address - Country:US
Practice Address - Phone:910-790-5315
Practice Address - Fax:910-790-5316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2448756Medicare UPIN