Provider Demographics
NPI:1417647314
Name:BEACHSIDE CHIROPRACTIC & WELLNESS, LLC
Entity Type:Organization
Organization Name:BEACHSIDE CHIROPRACTIC & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-460-2085
Mailing Address - Street 1:36468 EMERALD COAST PKWY STE 11101
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-0741
Mailing Address - Country:US
Mailing Address - Phone:850-460-2085
Mailing Address - Fax:
Practice Address - Street 1:36468 EMERALD COAST PKWY STE 11101
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-0741
Practice Address - Country:US
Practice Address - Phone:850-460-2085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-12
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty