1023014768 NPI number — DR. ROBERT HERSCHELL GOECKEL CHIROPRACTOR

Table of content: DR. ROBERT HERSCHELL GOECKEL CHIROPRACTOR (NPI 1023014768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023014768 NPI number — DR. ROBERT HERSCHELL GOECKEL CHIROPRACTOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOECKEL
Provider First Name:
ROBERT
Provider Middle Name:
HERSCHELL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
CHIROPRACTOR
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023014768
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
G4306 RICHFIELD ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48506-2022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-736-0501
Provider Business Mailing Address Fax Number:
810-736-4783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
G4306 RICHFIELD ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48506-2022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-736-0501
Provider Business Practice Location Address Fax Number:
810-736-4783
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301004573 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1658358 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 950B550150 . This is a "BCBS MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0B50891 . This is a "MEDICARE ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P73506 . This is a "BLUE CARE NET NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: XX05374 . This is a "HEALTH PLUS PROVIDER CODE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P01309793 . This is a "PALMETTO RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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