Provider Demographics
NPI:1922382415
Name:GOLDMAN, MICHAEL JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JASON
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 1:11620 WILSHIRE BLVD STE 710
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1781
Mailing Address - Country:US
Mailing Address - Phone:310-426-8229
Mailing Address - Fax:310-477-4755
Practice Address - Street 1:11620 WILSHIRE BLVD STE 710
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1781
Practice Address - Country:US
Practice Address - Phone:310-426-8229
Practice Address - Fax:310-477-4755
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor