Provider Demographics
NPI:1851429898
Name:COAKLEY CHIROPRACTIC & ACUPUNCTURE
Entity Type:Organization
Organization Name:COAKLEY CHIROPRACTIC & ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:COAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LIC AC
Authorized Official - Phone:508-533-6794
Mailing Address - Street 1:9 EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1515
Mailing Address - Country:US
Mailing Address - Phone:508-533-6794
Mailing Address - Fax:508-533-6757
Practice Address - Street 1:9 EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1515
Practice Address - Country:US
Practice Address - Phone:508-533-6794
Practice Address - Fax:508-533-6757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA877111N00000X
MA226570171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35604Medicare ID - Type Unspecified
MAT58283Medicare UPIN