Provider Demographics
NPI:1093827024
Name:GOLDBERG, TODD D (D C)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:D
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2594
Mailing Address - Country:US
Mailing Address - Phone:954-437-6660
Mailing Address - Fax:954-450-2253
Practice Address - Street 1:1900 N FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2594
Practice Address - Country:US
Practice Address - Phone:954-437-6660
Practice Address - Fax:954-450-2253
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL76939OtherBLUE CROSS BLUE SHIELD