Provider Demographics
NPI:1982299954
Name:NEWBURG CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:NEWBURG CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GOOLSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-290-8764
Mailing Address - Street 1:4310 BISHOP LN STE A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-4518
Mailing Address - Country:US
Mailing Address - Phone:502-290-8764
Mailing Address - Fax:502-290-9906
Practice Address - Street 1:4310 BISHOP LN STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4518
Practice Address - Country:US
Practice Address - Phone:502-290-8764
Practice Address - Fax:502-290-9906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty