Provider Demographics
NPI:1396563235
Name:COASTLINE SPINE & HEALTH CENTER VERO LLC
Entity type:Organization
Organization Name:COASTLINE SPINE & HEALTH CENTER VERO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO, PROVIDER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:484-707-2385
Mailing Address - Street 1:974 14TH LN
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4734
Mailing Address - Country:US
Mailing Address - Phone:484-707-2385
Mailing Address - Fax:
Practice Address - Street 1:974 14TH LN
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4734
Practice Address - Country:US
Practice Address - Phone:484-707-2385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty