Provider Demographics
NPI:1942264007
Name:GOEBEL, HAROLD JOHN JR (DC)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:JOHN
Last Name:GOEBEL
Suffix:JR
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 1:4309 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6819
Mailing Address - Country:US
Mailing Address - Phone:260-436-3783
Mailing Address - Fax:260-432-2330
Practice Address - Street 1:4309 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6819
Practice Address - Country:US
Practice Address - Phone:260-436-3783
Practice Address - Fax:260-432-2330
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001017A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000087061OtherBLUE CROSS AND BLUE SHIEL
IN4351502OtherAETNA INS. NUMBER
INT81848Medicare UPIN
IN217260Medicare ID - Type Unspecified