Provider Demographics
NPI:1023014768
Name:GOECKEL, ROBERT HERSCHELL (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HERSCHELL
Last Name:GOECKEL
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:G4306 RICHFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-2022
Mailing Address - Country:US
Mailing Address - Phone:810-736-0501
Mailing Address - Fax:810-736-4783
Practice Address - Street 1:G4306 RICHFIELD ROAD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-2022
Practice Address - Country:US
Practice Address - Phone:810-736-0501
Practice Address - Fax:810-736-4783
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1658358Medicaid
MI950B550150OtherBCBS MICHIGAN
MI0B50891OtherMEDICARE ID
MIP73506OtherBLUE CARE NET NUMBER
MIXX05374OtherHEALTH PLUS PROVIDER CODE
MIP01309793OtherPALMETTO RAILROAD MEDICARE
MIP01309793OtherPALMETTO RAILROAD MEDICARE