Provider Demographics
NPI:1639292907
Name:GULF COAST FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:GULF COAST FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-325-3717
Mailing Address - Street 1:7369 ALAMO CIR
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-1100
Mailing Address - Country:US
Mailing Address - Phone:251-948-2225
Mailing Address - Fax:
Practice Address - Street 1:7369 ALAMO CIRCLE
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-2771
Practice Address - Country:US
Practice Address - Phone:251-948-2225
Practice Address - Fax:188-850-5826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU71944Medicare UPIN
AL051526386Medicare PIN
ALK336Medicare PIN