Provider Demographics
NPI:1467635656
Name:COASTAL WELLNESS & PHYSICAL MEDICINE, INC
Entity Type:Organization
Organization Name:COASTAL WELLNESS & PHYSICAL MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-925-8266
Mailing Address - Street 1:37 W FAIRMONT AVE.
Mailing Address - Street 2:317
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406
Mailing Address - Country:US
Mailing Address - Phone:912-925-8266
Mailing Address - Fax:912-925-8264
Practice Address - Street 1:7395 HODGSON MEMORIAL DR
Practice Address - Street 2:STE101
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1505
Practice Address - Country:US
Practice Address - Phone:912-920-3900
Practice Address - Fax:912-921-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty