Coastal Connection Chiropractic Center

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

COASTAL CONNECTION CHIROPRACTIC CENTER

Practice address

800 25TH Ave S Ste a
North Myrtle Beach, SC 29582-4320

Phone

(843) 251-9526

NPI assigned

Jan 19, 2021

Organization subpart

No

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

Authorized official

Name

Jordan Tyler Miller, DCNPI 1780173393

Title

Ceo

Phone

(843) 251-9526

Specialties & licenses 1

Addresses

Other names 1

• Coastal Connection Chiropractic Center Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jordan Tyler Miller, D.C.

  • Chiropractor
  • North Myrtle Beach, SC
  • NPI 1780173393
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1611014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611014400000",
    "number": "1992395552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 25TH AVE S STE A",
            "city": "NORTH MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295824320",
            "telephone_number": "843-251-9526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 25TH AVE S STE A",
            "city": "NORTH MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295824320",
            "telephone_number": "843-251-9526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CONNECTION CHIROPRACTIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-19",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-12",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "TYLER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-251-9526",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Connection Chiropractic Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Joy V. Collins, P.T.
• Angela Comianos
• Steven Chase Connel, D.C.

• All providers in North Myrtle Beach, SC
• Chiropractor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; 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.