Provider Demographics
NPI:1801859087
Name:GOLDMAN, KENNETH M (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:M
Last Name:GOLDMAN
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 1:9823 DUNGAN RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-2201
Mailing Address - Country:US
Mailing Address - Phone:215-969-0099
Mailing Address - Fax:
Practice Address - Street 1:402 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1818
Practice Address - Country:US
Practice Address - Phone:215-750-8006
Practice Address - Fax:215-750-8007
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005180-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0638217000OtherPERSONAL CHOICE, KEYSTONE
PA11211721OtherCAQH
PA0043800OtherCIGNA
PA11211721OtherCAQH