Provider Demographics
NPI:1528229077
Name:COAST CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:COAST CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GIACALONE
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF CHIROPRACT
Authorized Official - Phone:310-376-8949
Mailing Address - Street 1:3201 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2290
Mailing Address - Country:US
Mailing Address - Phone:310-376-8949
Mailing Address - Fax:310-798-2569
Practice Address - Street 1:3201 PACIFIC COAST HWY
Practice Address - Street 2:SUITE A
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2290
Practice Address - Country:US
Practice Address - Phone:310-376-8949
Practice Address - Fax:310-798-2569
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COAST CHIROPRACTIC CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC8100Medicare UPIN