Provider Demographics
NPI:1306409396
Name:BRUCE A GOLDBERG D.C.,PA
Entity Type:Organization
Organization Name:BRUCE A GOLDBERG D.C.,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-624-5070
Mailing Address - Street 1:10887 N MILITARY TRL STE 4
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6528
Mailing Address - Country:US
Mailing Address - Phone:561-624-5070
Mailing Address - Fax:561-469-9706
Practice Address - Street 1:10887 N MILITARY TRL STE 4
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6528
Practice Address - Country:US
Practice Address - Phone:561-624-5070
Practice Address - Fax:561-469-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty