Basic Information
| Provider Information | |||||||||
| NPI: | 1619913951 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOELZ | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2052 N CLEVELAND AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606144505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732812225 | ||||||||
| FaxNumber: | 7732812226 | ||||||||
| Practice Location | |||||||||
| Address1: | 3900 WOODLAND AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158235800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 11/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 038-007867 | IL | Y | Chiropractic Providers | Chiropractor | 111N00000X | X008725-1 | NY | N | Chiropractic Providers | Chiropractor |
No ID Information.