1124360268 NPI number — DR. JOHN THOMAS COUGHLIN D.C.

Table of content: MRS. ILEANE D BEILER MS (NPI 1255686671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124360268 NPI number — DR. JOHN THOMAS COUGHLIN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COUGHLIN
Provider First Name:
JOHN
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124360268
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 700688
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78270-0688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-318-3007
Provider Business Mailing Address Fax Number:
210-468-0682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32357 US HWY 281 N
Provider Second Line Business Practice Location Address:
STE. 104
Provider Business Practice Location Address City Name:
BULUVERDE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-404-6050
Provider Business Practice Location Address Fax Number:
847-277-2991
Provider Enumeration Date:
03/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  12799 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12799 . This is a "CHIROPRACTIC LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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