Provider Demographics
NPI:1447431572
Name:ATLANTIC COASTAL WELLNESS INC
Entity Type:Organization
Organization Name:ATLANTIC COASTAL WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-775-1311
Mailing Address - Street 1:374 ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:WEST YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02673-4717
Mailing Address - Country:US
Mailing Address - Phone:508-775-1311
Mailing Address - Fax:508-775-1314
Practice Address - Street 1:374 ROUTE 28
Practice Address - Street 2:
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-4717
Practice Address - Country:US
Practice Address - Phone:508-775-1311
Practice Address - Fax:508-775-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY49164Medicare PIN