Provider Demographics
NPI:1407167778
Name:GOLDEN, FAYE JESSICA-MAURINE (DC)
Entity Type:Individual
Prefix:DR
First Name:FAYE
Middle Name:JESSICA-MAURINE
Last Name:GOLDEN
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 1:360 6TH ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4449
Mailing Address - Country:US
Mailing Address - Phone:770-256-2327
Mailing Address - Fax:
Practice Address - Street 1:360 6TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4449
Practice Address - Country:US
Practice Address - Phone:941-447-9739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002493500Medicaid
FLDN983ZMedicare PIN