Provider Demographics
NPI:1275863771
Name:COASTAL WELLNESS CENTER INC
Entity Type:Organization
Organization Name:COASTAL WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:954-752-2950
Mailing Address - Street 1:10000 W SAMPLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3936
Mailing Address - Country:US
Mailing Address - Phone:954-752-2950
Mailing Address - Fax:954-752-7363
Practice Address - Street 1:10000 W SAMPLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3936
Practice Address - Country:US
Practice Address - Phone:954-752-2950
Practice Address - Fax:954-752-7363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty