Provider Demographics
NPI:1740460179
Name:COASTAL CARE CHIROPRACTIC
Entity type:Organization
Organization Name:COASTAL CARE CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:ALICANTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-422-0022
Mailing Address - Street 1:170 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3510
Mailing Address - Country:US
Mailing Address - Phone:631-422-0022
Mailing Address - Fax:631-422-0051
Practice Address - Street 1:170 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3510
Practice Address - Country:US
Practice Address - Phone:631-422-0022
Practice Address - Fax:631-422-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXCWFE1Medicare PIN