Provider Demographics
NPI:1770680258
Name:GOLDBERG, SCOTT JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JASON
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 1:14201 W SUNRISE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3207
Mailing Address - Country:US
Mailing Address - Phone:954-336-7338
Mailing Address - Fax:954-397-7701
Practice Address - Street 1:14201 W SUNRISE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3207
Practice Address - Country:US
Practice Address - Phone:954-336-7338
Practice Address - Fax:954-397-7701
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor