Provider Demographics
NPI:1386645349
Name:GOULD, STEVEN JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JAY
Last Name:GOULD
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:KS
Mailing Address - Zip Code:67025-0190
Mailing Address - Country:US
Mailing Address - Phone:316-542-3400
Mailing Address - Fax:316-542-3404
Practice Address - Street 1:126 N. MAIN
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:KS
Practice Address - Zip Code:67025
Practice Address - Country:US
Practice Address - Phone:316-542-3400
Practice Address - Fax:316-542-3404
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3953111NR0200X
OK3111111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060952OtherBLUE CROSS BLUE SHIELD
KSU37365Medicare UPIN
KS060997Medicare ID - Type UnspecifiedCHIROPRACTOR