Provider Demographics
NPI:1780679571
Name:GOETZ, CHAD (NMD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
Last Name:GOETZ
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16286 SOUTH SUNLAND GIN ROAD
Mailing Address - Street 2:
Mailing Address - City:ARIZONA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85123
Mailing Address - Country:US
Mailing Address - Phone:520-494-8077
Mailing Address - Fax:502-494-8081
Practice Address - Street 1:16286 SOUTH SUNLAND GIN ROAD
Practice Address - Street 2:
Practice Address - City:ARIZONA CITY
Practice Address - State:AZ
Practice Address - Zip Code:85123
Practice Address - Country:US
Practice Address - Phone:520-494-8077
Practice Address - Fax:520-494-8081
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04-838175F00000X, 175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMG1273856OtherDEA NUMBER