Provider Demographics
NPI:1891123493
Name:GOLENBERG, SANFORD L (DC)
Entity Type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:L
Last Name:GOLENBERG
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 1:26 E PARK DR STE 105
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-5003
Mailing Address - Country:US
Mailing Address - Phone:740-592-4229
Mailing Address - Fax:740-592-4010
Practice Address - Street 1:26 E PARK DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-5003
Practice Address - Country:US
Practice Address - Phone:740-592-4229
Practice Address - Fax:740-592-4010
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0095255Medicaid
OHH198470Medicare PIN