Provider Demographics
NPI:1861014086
Name:GOETZ CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:GOETZ CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LUCAS
Authorized Official - Last Name:GOETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-293-3195
Mailing Address - Street 1:3536 JERSEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2223
Mailing Address - Country:US
Mailing Address - Phone:563-200-9188
Mailing Address - Fax:
Practice Address - Street 1:3536 JERSEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2223
Practice Address - Country:US
Practice Address - Phone:563-200-9188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty