=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164799532
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDSTEIN CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2011
-----------------------------------------------------
Last Update Date | 11/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19350 BUSINESS CENTER DR STE 103 NORTHRIDGE, CA 913246440
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91324-6440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-993-3668
-----------------------------------------------------
Fax | 818-993-0759
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19350 BUSINESS CENTER DR STE 103 NORTHRIDGE, CA 913246440
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91324-6440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-993-3668
-----------------------------------------------------
Fax | 818-993-0759
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SETH D GOLDSTEIN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 818-993-3668
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NI0013X
-----------------------------------------------------
Taxonomy Name | Independent Medical Examiner Chiropractor
-----------------------------------------------------
License Number | DC14378
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------