Provider Demographics
NPI:1881896868
Name:COASTAL CHIROPRACTIC AND REHAB
Entity type:Organization
Organization Name:COASTAL CHIROPRACTIC AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:STACEY
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:727-842-2111
Mailing Address - Street 1:5901 US HIGHWAY 19
Mailing Address - Street 2:SUITE 10
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2960
Mailing Address - Country:US
Mailing Address - Phone:727-842-2111
Mailing Address - Fax:727-842-2118
Practice Address - Street 1:5901 US HIGHWAY 19
Practice Address - Street 2:SUITE 10
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2960
Practice Address - Country:US
Practice Address - Phone:727-842-2111
Practice Address - Fax:727-842-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-02
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty