Provider Demographics
NPI:1639153604
Name:GOELDI, JOHN JEFFREY (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JEFFREY
Last Name:GOELDI
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 1:8988 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9183
Mailing Address - Country:US
Mailing Address - Phone:843-764-3200
Mailing Address - Fax:843-764-0220
Practice Address - Street 1:8988 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9183
Practice Address - Country:US
Practice Address - Phone:843-764-3200
Practice Address - Fax:843-764-0220
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH0991Medicaid
SCCH0991Medicaid
SCT250510281Medicare ID - Type UnspecifiedMEDICARE