Provider Demographics
NPI:1467796375
Name:GOEHL, JUSTIN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MICHAEL
Last Name:GOEHL
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 1:18 OLD ETNA RD
Mailing Address - Street 2:PRIMARY CARE/HEATER ROAD
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1937
Mailing Address - Country:US
Mailing Address - Phone:603-650-4000
Mailing Address - Fax:
Practice Address - Street 1:18 OLD ETNA RD
Practice Address - Street 2:PRIMARY CARE/HEATER ROAD
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1937
Practice Address - Country:US
Practice Address - Phone:603-650-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010021111N00000X
NH994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3106393Medicaid