Provider Demographics
NPI:1891393872
Name:COMMUNITY CARE CHIROPRACTIC AND REHAB CENTER, LLC
Entity Type:Organization
Organization Name:COMMUNITY CARE CHIROPRACTIC AND REHAB CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GOOLSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-350-5974
Mailing Address - Street 1:4075 PINE RIDGE RD STE 8
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-4004
Mailing Address - Country:US
Mailing Address - Phone:239-325-9640
Mailing Address - Fax:239-431-6782
Practice Address - Street 1:4075 PINE RIDGE RD STE 8
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-4004
Practice Address - Country:US
Practice Address - Phone:239-325-9640
Practice Address - Fax:239-431-6782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty