MEDICARE: JOHN D. GOOLSBY, DC LLC

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

General Provider Information

NPI Number	:	1912257965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN D. GOOLSBY, DC LLC

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	:	PRESIDENT/OWNER
Name	:	DR. JOHN DAVID GOOLSBY
Credential	:	D.C.
Telephone Number	:	864-350-5974

Provider Enumeration Date	:	09/18/2012
Last Update Date	:	09/18/2012

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