Provider Demographics
NPI:1790105815
Name:COFFEY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:COFFEY CHIROPRACTIC LLC
Other - Org Name:COFFEY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:941-366-7111
Mailing Address - Street 1:2700 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 17
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-4530
Mailing Address - Country:US
Mailing Address - Phone:941-366-7111
Mailing Address - Fax:
Practice Address - Street 1:2700 S TAMIAMI TRL
Practice Address - Street 2:SUITE 17
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4530
Practice Address - Country:US
Practice Address - Phone:941-366-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9942261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center