Provider Demographics
NPI:1033277538
Name:GOESEL CHIROPRACTIC HEALTH CENTER SC
Entity Type:Organization
Organization Name:GOESEL CHIROPRACTIC HEALTH CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:P
Authorized Official - Last Name:GOESEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-429-6061
Mailing Address - Street 1:6700 W 167TH STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477
Mailing Address - Country:US
Mailing Address - Phone:708-429-6061
Mailing Address - Fax:708-429-6092
Practice Address - Street 1:6700 W 167TH STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477
Practice Address - Country:US
Practice Address - Phone:708-429-6061
Practice Address - Fax:708-429-6092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042007425111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001683022OtherBLUE CROSS BLUE SHIELD
IL579600Medicare PIN
U40878Medicare UPIN