Provider Demographics
NPI:1528187531
Name:GONINAN, STEVEN L (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:L
Last Name:GONINAN
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 1:295 W PIKE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-4877
Mailing Address - Country:US
Mailing Address - Phone:678-225-4800
Mailing Address - Fax:678-225-4801
Practice Address - Street 1:295 W PIKE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-4877
Practice Address - Country:US
Practice Address - Phone:678-225-4800
Practice Address - Fax:678-225-4801
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA07151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHNQMedicare ID - Type UnspecifiedPROVIDER NUMBER
GAU98580Medicare UPIN