Provider Demographics
NPI:1700915519
Name:GOULOOZE, MARTIN JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JOHN
Last Name:GOULOOZE
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 1:13925 W MEEKER BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4431
Mailing Address - Country:US
Mailing Address - Phone:602-618-0444
Mailing Address - Fax:
Practice Address - Street 1:1850 MCCULLOCH BLVD N STE C5
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5798
Practice Address - Country:US
Practice Address - Phone:928-855-1220
Practice Address - Fax:928-855-1221
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ152098OtherMEDICARE