Organization
GOLD COAST CHIROPRACTIC & REHAB P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK MARIEN DC (OWNER)
(239) 542-7660
Entity
Organization
Contact information
Practice address
4210 DEL PRADO BLVD S, CAPE CORAL, FL 33904-7166
(239) 542-7660
Mailing address
4210 DEL PRADO BLVD S, CAPE CORAL, FL 33904-7166
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE1877
RAILRAOD MEDICARE PART B GROUP NUMBER
FL
01
—
P00277193
RAILROAD MEDICARE PART B PTAN
FL
Enumeration date
01/09/2008
Last updated
06/05/2008
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