Provider Demographics
NPI:1245624048
Name:COASTLINE CHIROPRACTIC AND REHABILITATION CENTER
Entity type:Organization
Organization Name:COASTLINE CHIROPRACTIC AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KLINGENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-610-7743
Mailing Address - Street 1:1536 FORDING ISLAND RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1120
Mailing Address - Country:US
Mailing Address - Phone:616-610-7743
Mailing Address - Fax:
Practice Address - Street 1:1536 FORDING ISLAND RD
Practice Address - Street 2:SUITE 106
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-1120
Practice Address - Country:US
Practice Address - Phone:616-610-7743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC.3983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty