Organization · NPI-2

Coastal Spine And Sport Of Daytona Beach

Clinic/Center · Daytona Beach, FL

NPI number1346679610
StatusActive
Last updated in NPPESNov 6, 2013

Details

NPI
1346679610
Entity type
Organization (NPI-2)
Legal business name
Coastal Spine And Sport Of Daytona Beach
Organization subpart
No
Enumeration date
Nov 6, 2013
Last updated
Nov 6, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/CenterCH9679FLYes

Practice location

912 S Ridgewood Ave
Ste. D
Daytona Beach, FL 32114-5349

Phone 407-496-7998

Mailing address

912 S Ridgewood Ave
Ste. D
Daytona Beach, FL 32114-5349

Authorized official

Chris Lee Wojcik
Managing Member
4074967998

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