Provider Demographics
NPI:1558378745
Name:GOLDSON, FIDEL S JR (DC, PT)
Entity Type:Individual
Prefix:DR
First Name:FIDEL
Middle Name:S
Last Name:GOLDSON
Suffix:JR
Gender:M
Credentials:DC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10796 PINES BLVD.
Mailing Address - Street 2:#105
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-2129
Mailing Address - Country:US
Mailing Address - Phone:954-367-4888
Mailing Address - Fax:954-367-4889
Practice Address - Street 1:10796 PINES BLVD.
Practice Address - Street 2:#105
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-2129
Practice Address - Country:US
Practice Address - Phone:954-367-4888
Practice Address - Fax:954-367-4889
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9276111N00000X
FLPT19489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380230200Medicaid