1871595165 NPI number — GOBEN CHIROPRACTIC OFFICES, PLLC

Table of content: (NPI 1871595165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871595165 NPI number — GOBEN CHIROPRACTIC OFFICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOBEN CHIROPRACTIC OFFICES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1871595165
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 GAGEL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40216-4008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-366-7386
Provider Business Mailing Address Fax Number:
502-366-2222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 GAGEL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40216-4008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-366-7386
Provider Business Practice Location Address Fax Number:
502-366-2222
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GOBEN
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CHIROPRACTOR/OWNER
Authorized Official Telephone Number:
502-366-7386

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4166 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000221631 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1131052 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 85002103 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000050861 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1136138 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 85041663 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 350036040 . This is a "UNITED RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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