Provider Demographics
NPI:1952329005
Name:GOLAS, WILLIAM JOHN (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOHN
Last Name:GOLAS
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 1:64060 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49057-9692
Mailing Address - Country:US
Mailing Address - Phone:269-208-3122
Mailing Address - Fax:
Practice Address - Street 1:1404 E NAPIER AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-2136
Practice Address - Country:US
Practice Address - Phone:269-926-8213
Practice Address - Fax:269-926-8215
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950A15030OtherBLUE CROSS BLUE SHIELD
MI3268816Medicaid
MI3268816Medicaid
MI950A15030OtherBLUE CROSS BLUE SHIELD