Healthcare Provider Details

I. General information

NPI: 1447206263
Provider Name (Legal Business Name): ALLAN GOETZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 RANDALL RD
SOUTH ELGIN IL
60177-2248
US

IV. Provider business mailing address

329 RANDALL RD
SOUTH ELGIN IL
60177-2248
US

V. Phone/Fax

Practice location:
  • Phone: 847-742-5200
  • Fax:
Mailing address:
  • Phone: 847-742-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: