Provider Demographics
NPI:1477657948
Name:GOOZDICH, LEE (D C)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:GOOZDICH
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SCENIC RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-2342
Mailing Address - Country:US
Mailing Address - Phone:724-942-3836
Mailing Address - Fax:
Practice Address - Street 1:565 NATIONAL PIKE W
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15417-9221
Practice Address - Country:US
Practice Address - Phone:724-785-7633
Practice Address - Fax:724-785-7632
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC0035424L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor