Provider Demographics
NPI:1790900314
Name:COIT ROAD HEALTH ENTERPRISES LLC
Entity Type:Organization
Organization Name:COIT ROAD HEALTH ENTERPRISES LLC
Other - Org Name:DAVIS CHIROPRACTIC & ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILES
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-612-0707
Mailing Address - Street 1:2801 W PARKER RD STE 6
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-7934
Mailing Address - Country:US
Mailing Address - Phone:972-612-0707
Mailing Address - Fax:972-612-2263
Practice Address - Street 1:2801 W PARKER RD STE 6
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-7934
Practice Address - Country:US
Practice Address - Phone:972-612-0707
Practice Address - Fax:972-612-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1114196219OtherINDIVIDUAL NPI
TX=========OtherTAX ID
TX=========OtherTAX ID