Provider Demographics
NPI:1891730297
Name:SEACOAST FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:SEACOAST FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-295-4900
Mailing Address - Street 1:512 ARNOLD AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2562
Mailing Address - Country:US
Mailing Address - Phone:732-295-4900
Mailing Address - Fax:732-295-8877
Practice Address - Street 1:512 ARNOLD AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08742-2562
Practice Address - Country:US
Practice Address - Phone:732-295-4900
Practice Address - Fax:732-295-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00480700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty