NPIMap

Organization Active NPI

Coley Chiropractic PA

  • Chiropractor
  • W Melbourne, FL
National Provider Identifier
1760668388
Registry record updated Oct 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
COLEY CHIROPRACTIC PA
Practice address
635 S Wickham Rd
Suite 203
W Melbourne, FL 32904-1436
Phone
(321) 723-1011
Fax
(321) 723-1110
NPI assigned
Jan 14, 2008
Last updated
Oct 5, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2009

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

Authorized official

Name
Dr. Kimmie L. Coley, D.C.NPI 1346377942
Title
President/Owner
Phone
(321) 723-1011

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU Primary

Addresses

Primary practice location

635 S Wickham Rd
Suite 203
W Melbourne, FL 32904-1436

Mailing address

635 S Wickham Rd
Suite 203
W Melbourne, FL 32904-1436
Phone (321) 723-1011

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080714000399 FL Part B Supplier - Clinic/Group Practice 5294808911 Receives reassigned benefits from 1 practitioner
Practice locations: W Melbourne, FL

National Provider Directory

National Provider Directory

Locations

635 S Wickham Rd
Ste 203
West Melbourne, FL 32904
Phone (321) 723-1011

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254700800000",
    "number": "1760668388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 S WICKHAM RD",
            "address_2": "SUITE 203",
            "city": "W MELBOURNE",
            "state": "FL",
            "postal_code": "329041436",
            "telephone_number": "321-723-1011",
            "fax_number": "321-723-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 S WICKHAM RD",
            "address_2": "SUITE 203",
            "city": "W MELBOURNE",
            "state": "FL",
            "postal_code": "329041436",
            "telephone_number": "321-723-1011",
            "fax_number": "321-723-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLEY CHIROPRACTIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-14",
        "last_updated": "2009-10-05",
        "status": "A",
        "authorized_official_last_name": "COLEY",
        "authorized_official_first_name": "KIMMIE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "321-723-1011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in W Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.