Blue Water Coastal, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC29910 Issued in CA

Legal business name

BLUE WATER COASTAL, LLC

Practice address

785 Grand Ave
#100
Carlsbad, CA 92008-2370

Phone

(760) 729-3200

Fax

(760) 729-3201

NPI assigned

Oct 5, 2012

Organization subpart

No

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

Authorized official

Name

Sarah C Wilkie, D.C.

Title

Owner/Chiropractor

Phone

(760) 729-3200

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1349395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349395200000",
    "number": "1063764686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1176",
            "city": "CARDIFF",
            "state": "CA",
            "postal_code": "920077176",
            "telephone_number": "858-509-7999",
            "fax_number": "858-509-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "785 GRAND AVE",
            "address_2": "#100",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920082370",
            "telephone_number": "760-729-3200",
            "fax_number": "760-729-3201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER COASTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-05",
        "last_updated": "2012-10-05",
        "status": "A",
        "authorized_official_last_name": "WILKIE",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/CHIROPRACTOR",
        "authorized_official_telephone_number": "760-729-3200",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC29910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Alexander Bloch, OD
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• Nellie Ann Blunt, PA-C
• Christopher Bo, MD
• Kylie Bobertz
• Jordan Bogdan

• Chiropractor in Carlsbad, CA
• Providers in Carlsbad, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2012; 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.