Provider Demographics
NPI:1467795831
Name:COCOA CHIROPRACTIC & INJURY CENTER, INC.
Entity Type:Organization
Organization Name:COCOA CHIROPRACTIC & INJURY CENTER, INC.
Other - Org Name:COCOA ACCIDENT & INJURY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JIM
Authorized Official - Last Name:TRASTELIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-847-7118
Mailing Address - Street 1:6284 PARADISE ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6962
Mailing Address - Country:US
Mailing Address - Phone:386-847-7118
Mailing Address - Fax:
Practice Address - Street 1:200 WILLARD ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-8001
Practice Address - Country:US
Practice Address - Phone:321-735-9050
Practice Address - Fax:321-735-9429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9957111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty