Provider Demographics
NPI:1215010699
Name:GOLDENBERG, LEE ROGER (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:ROGER
Last Name:GOLDENBERG
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 1:140 VILLAGE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6436
Mailing Address - Country:US
Mailing Address - Phone:205-981-8090
Mailing Address - Fax:
Practice Address - Street 1:140 VILLAGE ST STE 201
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6436
Practice Address - Country:US
Practice Address - Phone:205-981-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051540443Medicare PIN