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General NPI Number Information
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NPI Number | 1205030509
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Entity Type | Organization
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Legal Business Name | GOEBEL CHIROPRACTIC AND FAMILY WELLNESS, P.A.
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1115 VICKSBURG LN N SUITE 11
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City | PLYMOUTH
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State | MN
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Zip | 55447-3215
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Country | US
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Telephone | 763-473-7000
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Fax | 763-473-7002
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Provider Business Mailing Address
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Address Line | 1115 VICKSBURG LN N SUITE 11
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City | PLYMOUTH
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State | MN
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Zip | 55447-3215
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Country | US
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Telephone | 763-473-7000
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Fax | 763-473-7002
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | DR. PATRICK LEE GOEBEL
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Credential | DC
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Telephone | 763-473-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4932
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License Number State | MN
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