Provider Demographics
NPI:1780887570
Name:GOBLE, CHERYL E (DC)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:E
Last Name:GOBLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E PEARL ST
Mailing Address - Street 2:PO BOX 250
Mailing Address - City:WINAMAC
Mailing Address - State:IN
Mailing Address - Zip Code:46996-1311
Mailing Address - Country:US
Mailing Address - Phone:574-946-4113
Mailing Address - Fax:574-946-4552
Practice Address - Street 1:116 E PEARL ST
Practice Address - Street 2:
Practice Address - City:WINAMAC
Practice Address - State:IN
Practice Address - Zip Code:46996-1311
Practice Address - Country:US
Practice Address - Phone:574-946-4113
Practice Address - Fax:574-946-4552
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000878A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN223660AMedicare ID - Type Unspecified