MEDICARE: DR. JOHN DAVID GOOLSBY DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH10161	FL
2	111N00000X	Chiropractor	3001	SC

General Provider Information

NPI Number	:	1194780601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DAVID GOOLSBY DC

Provider Business Mailing Address
First Line	:	556 FLORIDA CIR S
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-2531
Country	:	US
Telephone Number	:	864-350-5974
Fax Number	:

Provider Business Practice Location Address
First Line	:	556 FLORIDA CIR S
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-2531
Country	:	US
Telephone Number	:	864-350-5974
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	12/16/2011

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Directions to “ DR. JOHN DAVID GOOLSBY DC” Practice Location

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