Provider Demographics
NPI:1578622114
Name:GOLDSMITH, ELI MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:ELI
Middle Name:MARK
Last Name:GOLDSMITH
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 1:2607 FREEDOM PKWY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9176
Mailing Address - Country:US
Mailing Address - Phone:678-513-8848
Mailing Address - Fax:678-513-6614
Practice Address - Street 1:2607 FREEDOM PKWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9176
Practice Address - Country:US
Practice Address - Phone:678-513-8848
Practice Address - Fax:678-513-6614
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005900111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
35ZCFZWMedicare ID - Type Unspecified
U70899Medicare UPIN