Provider Demographics
NPI:1669695326
Name:EP GOSLINE CHIROPRACTIC CLINIC PA
Entity type:Organization
Organization Name:EP GOSLINE CHIROPRACTIC CLINIC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GOSLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:478-923-5511
Mailing Address - Street 1:235 CARL VINSON PKWY
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5815
Mailing Address - Country:US
Mailing Address - Phone:478-923-5511
Mailing Address - Fax:478-923-5509
Practice Address - Street 1:235 CARL VINSON PKWY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5815
Practice Address - Country:US
Practice Address - Phone:478-923-5511
Practice Address - Fax:478-923-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR001710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBSDMedicare PIN