Provider Demographics
NPI:1518917905
Name:GOLDMAN, JOEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:GOLDMAN
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 1:115 N PACIFIC HWY
Mailing Address - Street 2:P.O. BOX 432
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-9637
Mailing Address - Country:US
Mailing Address - Phone:541-535-3062
Mailing Address - Fax:541-535-6449
Practice Address - Street 1:115 N PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540-9637
Practice Address - Country:US
Practice Address - Phone:541-535-3062
Practice Address - Fax:541-535-6449
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor