Provider Demographics
NPI:1598758070
Name:GOLDMAN, RITA (DC)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 ASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-9065
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1335 SOUTH GATE PLAZA
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056
Practice Address - Country:US
Practice Address - Phone:606-564-4213
Practice Address - Fax:606-564-4406
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4030111N00000X
OH2442111N00000X
KS01-03942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000043145OtherANTHEM PIN
OH966236Medicaid
KY4030C-01OtherHUMANA PIN
KY1036638OtherAETNA PIN
KY607727OtherA C N PIN
KY4970OtherCHA PIN
KY000000043145OtherANTHEM PIN
KY6059101Medicare ID - Type Unspecified