Space Coast Chiropractic Inc

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH8196 Issued in FL

Legal business name

SPACE COAST CHIROPRACTIC INC

Practice address

1070 S Wickham Road
Space Coast Chiropractic Inc
West Melbourne, FL 32904

Phone

(321) 729-9000

Fax

(321) 722-3997

NPI assigned

Mar 22, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kimmie L Coley, DC

Title

Chiropractor

Phone

(321) 729-9000

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013033927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 S WICKHAM ROAD",
            "address_2": "SPACE COAST CHIROPRACTIC INC",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "32904",
            "telephone_number": "321-729-9000",
            "fax_number": "321-722-3997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1070 S WICKHAM ROAD",
            "address_2": "SPACE COAST CHIROPRACTIC INC",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "32904",
            "telephone_number": "321-729-9000",
            "fax_number": "321-722-3997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST CHIROPRACTIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COLEY",
        "authorized_official_first_name": "KIMMIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "321-729-9000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH8196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACS-DEPARTMENT OF LABOR",
            "identifier": "1628516000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in West Melbourne, FL
• Providers in West Melbourne, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.