Provider Demographics
NPI:1225039282
Name:GOLZ, MICHAEL W (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:GOLZ
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 1:784 FRANKLIN AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1920
Mailing Address - Country:US
Mailing Address - Phone:201-891-4100
Mailing Address - Fax:201-891-0014
Practice Address - Street 1:784 FRANKLIN AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-1920
Practice Address - Country:US
Practice Address - Phone:201-891-4100
Practice Address - Fax:201-891-0014
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3137111N00000X
NJ38MC00313700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
520639Medicare ID - Type Unspecified
T87631Medicare UPIN