Provider Demographics
NPI:1063489508
Name:GOLDSTEIN, SETH A (DC)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:A
Last Name:GOLDSTEIN
Suffix:
Gender:M
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:PO BOX 1465
Mailing Address - Street 2:
Mailing Address - City:CANNON BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97110-1465
Mailing Address - Country:US
Mailing Address - Phone:503-436-0335
Mailing Address - Fax:503-436-0604
Practice Address - Street 1:231 N HEMLOCK ST
Practice Address - Street 2:SUITE 106
Practice Address - City:CANNON BEACH
Practice Address - State:OR
Practice Address - Zip Code:97110-1465
Practice Address - Country:US
Practice Address - Phone:503-436-0335
Practice Address - Fax:503-436-0604
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR182758Medicaid
OR112681Medicare PIN
OR182758Medicaid