Provider Demographics
NPI:1053441964
Name:GOLDBERG, KARYN JILL (DC)
Entity Type:Individual
Prefix:DR
First Name:KARYN
Middle Name:JILL
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 WILLOW LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4941
Mailing Address - Country:US
Mailing Address - Phone:805-494-4537
Mailing Address - Fax:805-497-7668
Practice Address - Street 1:3180 WILLOW LN
Practice Address - Street 2:SUITE 110
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-4941
Practice Address - Country:US
Practice Address - Phone:805-494-4537
Practice Address - Fax:805-497-7668
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 20604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC20604OtherDC
CAU13470Medicare UPIN