Provider Demographics
NPI:1659460806
Name:SOUTHCOAST CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:SOUTHCOAST CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOTELHO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-991-8400
Mailing Address - Street 1:651 ORCHARD ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02744-1008
Mailing Address - Country:US
Mailing Address - Phone:508-991-8400
Mailing Address - Fax:508-991-8788
Practice Address - Street 1:651 ORCHARD ST
Practice Address - Street 2:SUITE 206
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02744-1008
Practice Address - Country:US
Practice Address - Phone:508-991-8400
Practice Address - Fax:508-991-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2386111N00000X
MA2462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9799915Medicaid
MA9799915Medicaid