Provider Demographics
NPI:1568556116
Name:GOLDBERG, STEVEN L (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:L
Last Name:GOLDBERG
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 1:7370 HODGSON MEMORIAL DR.
Mailing Address - Street 2:SUITE E3
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406
Mailing Address - Country:US
Mailing Address - Phone:912-351-0875
Mailing Address - Fax:912-351-0892
Practice Address - Street 1:7370 HODGSON MEMORIAL DR.
Practice Address - Street 2:SUITE E3
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-351-0875
Practice Address - Fax:912-351-0892
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA800003375OtherTAX ID
GA35ZCBCBMedicare ID - Type Unspecified
GAU25486Medicare UPIN