Provider Demographics
NPI:1205992179
Name:COFLIN CHIROPRACTIC GROUP,INC.
Entity type:Organization
Organization Name:COFLIN CHIROPRACTIC GROUP,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:COFLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-580-4321
Mailing Address - Street 1:1271 SHELL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:CA
Mailing Address - Zip Code:94517-1222
Mailing Address - Country:US
Mailing Address - Phone:925-580-4321
Mailing Address - Fax:
Practice Address - Street 1:5444 CLAYTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-4099
Practice Address - Country:US
Practice Address - Phone:925-672-6500
Practice Address - Fax:925-672-6502
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COFLIN CHIROPRACTIC GROUP,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-28
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU91825Medicare UPIN
CAZZZ24105ZMedicare PIN