Provider Demographics
NPI:1164602595
Name:JACQUES-MAYNES, GOLDBERRY SKEEL (DC)
Entity Type:Individual
Prefix:DR
First Name:GOLDBERRY
Middle Name:SKEEL
Last Name:JACQUES-MAYNES
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 1:50 PENNY LANE
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076
Mailing Address - Country:US
Mailing Address - Phone:831-761-2212
Mailing Address - Fax:831-851-3502
Practice Address - Street 1:50 PENNY LANE
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076
Practice Address - Country:US
Practice Address - Phone:831-761-2212
Practice Address - Fax:831-851-3502
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-300766111N00000X
CADC30766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC030766Medicare UPIN