Provider Demographics
NPI:1063305118
Name:COASTAL CHIROPRACTIC L.L.C.
Entity type:Organization
Organization Name:COASTAL CHIROPRACTIC L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-375-0131
Mailing Address - Street 1:27535 US HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4839
Mailing Address - Country:US
Mailing Address - Phone:843-793-9393
Mailing Address - Fax:
Practice Address - Street 1:1668 N PINE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2220
Practice Address - Country:US
Practice Address - Phone:843-793-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL CHIROPRACTIC L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty