Provider Demographics
NPI:1568537850
Name:DR C H LACOSTE PA
Entity Type:Organization
Organization Name:DR C H LACOSTE PA
Other - Org Name:OAKHURST CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:LACOSTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-391-9718
Mailing Address - Street 1:11206 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-4752
Mailing Address - Country:US
Mailing Address - Phone:727-391-9718
Mailing Address - Fax:727-391-9718
Practice Address - Street 1:11206 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-4752
Practice Address - Country:US
Practice Address - Phone:727-391-9718
Practice Address - Fax:727-391-9718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88165Medicare PIN
88165Medicare UPIN