Provider Demographics
NPI:1073756912
Name:GOLDMAN CHIROPRACTIC PL
Entity Type:Organization
Organization Name:GOLDMAN CHIROPRACTIC PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-592-5367
Mailing Address - Street 1:3467 PINE RIDGE RD
Mailing Address - Street 2:102
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3832
Mailing Address - Country:US
Mailing Address - Phone:239-592-5367
Mailing Address - Fax:239-592-5048
Practice Address - Street 1:3467 PINE RIDGE RD
Practice Address - Street 2:102
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-3832
Practice Address - Country:US
Practice Address - Phone:239-592-5367
Practice Address - Fax:239-592-5048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7506261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center