Provider Demographics
NPI:1255690319
Name:TERRY P ROTHSTEIN, D.C.P.A.
Entity Type:Organization
Organization Name:TERRY P ROTHSTEIN, D.C.P.A.
Other - Org Name:COASTAL CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ROTHSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-642-9500
Mailing Address - Street 1:5817 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3209
Mailing Address - Country:US
Mailing Address - Phone:561-642-9500
Mailing Address - Fax:561-642-9501
Practice Address - Street 1:5817 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3209
Practice Address - Country:US
Practice Address - Phone:561-642-9500
Practice Address - Fax:561-642-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22392Medicare PIN