Provider Demographics
NPI:1790115558
Name:COULSBY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:COULSBY CHIROPRACTIC, P.C.
Other - Org Name:PENINSULA CHIROPRACTIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:COULSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-640-0321
Mailing Address - Street 1:3065 ROSECRANS PL STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4854
Mailing Address - Country:US
Mailing Address - Phone:619-640-0321
Mailing Address - Fax:619-435-3158
Practice Address - Street 1:3065 ROSECRANS PL STE 108
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4854
Practice Address - Country:US
Practice Address - Phone:619-640-0321
Practice Address - Fax:619-435-3158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3718111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty