Healthcare Provider Details

I. General information

NPI: 1891123493
Provider Name (Legal Business Name): SANFORD L. GOLENBERG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 E PARK DR
ATHENS OH
45701-5003
US

IV. Provider business mailing address

26 E PARK DR STE 105
ATHENS OH
45701-5003
US

V. Phone/Fax

Practice location:
  • Phone: 740-592-4229
  • Fax: 740-592-4010
Mailing address:
  • Phone: 740-592-4229
  • Fax: 740-592-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number855
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: