Provider Demographics
NPI:1831966381
Name:COASTAL CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:COASTAL CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ZIELENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-977-8869
Mailing Address - Street 1:95126 GLADIOLUS PL
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-0035
Mailing Address - Country:US
Mailing Address - Phone:732-977-8869
Mailing Address - Fax:
Practice Address - Street 1:464073 STATE ROAD 200 STE 4
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-6307
Practice Address - Country:US
Practice Address - Phone:904-780-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center