Provider Demographics
NPI:1518419258
Name:THE MARTIN J GOULOOZE A DONNA J GOULOOZE FAMILY LIMITED PARTNERSHIP NU
Entity Type:Organization
Organization Name:THE MARTIN J GOULOOZE A DONNA J GOULOOZE FAMILY LIMITED PARTNERSHIP NU
Other - Org Name:SUN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOULOOZE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-618-0444
Mailing Address - Street 1:13925 W MEEKER BLVD
Mailing Address - Street 2:SUITE#19
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4430
Mailing Address - Country:US
Mailing Address - Phone:623-584-2328
Mailing Address - Fax:623-584-4796
Practice Address - Street 1:13925 W MEEKER BLVD
Practice Address - Street 2:SUITE#19
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4430
Practice Address - Country:US
Practice Address - Phone:623-584-2328
Practice Address - Fax:623-584-4796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ152098Medicare UPIN