=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285092973
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW GOLDBAUGH D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2016
-----------------------------------------------------
Last Update Date | 02/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 NOBLESTOWN RD 115
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15205-3956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-444-4455
-----------------------------------------------------
Fax | 412-444-4458
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 VERNON AVE
-----------------------------------------------------
City | WHEELING
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26003-5153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-639-0315
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC011125
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------