Provider Demographics
NPI:1720073257
Name:DR MITCHELL GOOZDICH INC
Entity Type:Organization
Organization Name:DR MITCHELL GOOZDICH INC
Other - Org Name:GOOZDICH FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOOZDICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-985-5505
Mailing Address - Street 1:113 N LEAVITT RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1110
Mailing Address - Country:US
Mailing Address - Phone:440-985-5505
Mailing Address - Fax:440-985-5507
Practice Address - Street 1:113 N LEAVITT RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-1110
Practice Address - Country:US
Practice Address - Phone:440-985-5505
Practice Address - Fax:440-985-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000257029OtherANTHEM BLUE CROSS
OH2483825Medicaid
9332731Medicare ID - Type Unspecified