Provider Demographics
NPI:1922305788
Name:GOLDMAN, EDEN JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:EDEN
Middle Name:JOSEPH
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 1:2211 CORINTH AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1650
Mailing Address - Country:US
Mailing Address - Phone:310-990-9648
Mailing Address - Fax:424-208-3752
Practice Address - Street 1:2211 CORINTH AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1650
Practice Address - Country:US
Practice Address - Phone:310-990-9648
Practice Address - Fax:424-208-3752
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor