Provider Demographics
NPI:1669248373
Name:COASTAL CHIROPRACTIC AND FAMILY WELLNESS
Entity type:Organization
Organization Name:COASTAL CHIROPRACTIC AND FAMILY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:PARRIS
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-413-5949
Mailing Address - Street 1:316 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-9440
Mailing Address - Country:US
Mailing Address - Phone:336-413-5949
Mailing Address - Fax:
Practice Address - Street 1:100 TIMBER TRAIL RD STE 203
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-9430
Practice Address - Country:US
Practice Address - Phone:912-643-2077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center