Provider Demographics
NPI:1669740932
Name:COAST CHIROPRACTIC CENTERS, INC.
Entity type:Organization
Organization Name:COAST CHIROPRACTIC CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:HARCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-278-3344
Mailing Address - Street 1:7270 COLLEGE PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5658
Mailing Address - Country:US
Mailing Address - Phone:239-278-3344
Mailing Address - Fax:239-278-3159
Practice Address - Street 1:7270 COLLEGE PKWY STE 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5658
Practice Address - Country:US
Practice Address - Phone:239-278-3344
Practice Address - Fax:239-278-3159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9690111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty