Provider Demographics
NPI:1891894820
Name:GOLD COAST CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:GOLD COAST CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:CELESTE
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-944-0563
Mailing Address - Street 1:120 BIRMINGHAM DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1757
Mailing Address - Country:US
Mailing Address - Phone:760-944-0563
Mailing Address - Fax:760-944-6773
Practice Address - Street 1:120 BIRMINGHAM DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CARDIFF BY THE SEA
Practice Address - State:CA
Practice Address - Zip Code:92007-1757
Practice Address - Country:US
Practice Address - Phone:760-944-0563
Practice Address - Fax:760-944-6773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21155111N00000X
CADC20080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty