Provider Demographics
NPI:1770934135
Name:GOLDBAUGH CHIROPRACTIC AND SPORTS REHABILITATION
Entity type:Organization
Organization Name:GOLDBAUGH CHIROPRACTIC AND SPORTS REHABILITATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:GENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-530-5500
Mailing Address - Street 1:8 VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5153
Mailing Address - Country:US
Mailing Address - Phone:412-553-5500
Mailing Address - Fax:412-379-0709
Practice Address - Street 1:8 VERNON AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5153
Practice Address - Country:US
Practice Address - Phone:412-553-5500
Practice Address - Fax:412-379-0709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty