Provider Demographics
NPI:1740337484
Name:GREGORY P GOIHL P.A
Entity type:Organization
Organization Name:GREGORY P GOIHL P.A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GOIHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-345-4140
Mailing Address - Street 1:105 S LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55041-1640
Mailing Address - Country:US
Mailing Address - Phone:651-345-4140
Mailing Address - Fax:651-345-4240
Practice Address - Street 1:105 S LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MN
Practice Address - Zip Code:55041-1640
Practice Address - Country:US
Practice Address - Phone:651-345-4140
Practice Address - Fax:651-345-4240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN058H2GOOtherBCBS PROVIDER NUMBER
MNU87523Medicare UPIN