Provider Demographics
NPI:1851344675
Name:GOSHORN, CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:GOSHORN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:CHARLES
Other - Middle Name:
Other - Last Name:GOSHORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:725 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2450
Mailing Address - Country:US
Mailing Address - Phone:585-671-0934
Mailing Address - Fax:
Practice Address - Street 1:725 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2450
Practice Address - Country:US
Practice Address - Phone:585-671-0934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0421Medicare ID - Type Unspecified