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General NPI Number Information
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NPI Number | 1053313205
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Entity Type | Individual
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Provider Name | BRUEN C GOOLSBY DC
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 01/27/2009
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Provider Practice Location Address
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Address Line | 13210 US HIGHWAY 87 W
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City | LAVERNIA
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State | TX
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Zip | 78121
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Country | US
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Telephone | 830-253-7246
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 675
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City | LA VERNIA
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State | TX
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Zip | 78121-0675
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Country | US
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Telephone | 830-253-7246
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 9067
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License Number State | TX
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