Healthcare Provider Details

I. General information

NPI: 1316930498
Provider Name (Legal Business Name): ROBERT A GOLDBERG DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR UNIT MEDDAC
FT CARSON CO
80913-4604
US

IV. Provider business mailing address

1650 COCHRANE CIRCLE DEPT OF SURGERY/CHIROPRACTIC FORT CARSON ARMY BASE
FT CARSON CO
80913
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7120
  • Fax:
Mailing address:
  • Phone: 724-387-2455
  • Fax: 724-387-2456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC007714L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: