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General NPI Number Information
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NPI Number | 1558378745
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Entity Type | Individual
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Provider Name | FIDEL S GOLDSON JR. D.C., P.T.
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 02/25/2009
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Provider Practice Location Address
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Address Line | 10796 PINES BLVD. #105
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-2129
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Country | US
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Telephone | 954-367-4888
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Fax | 954-367-4889
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Provider Business Mailing Address
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Address Line | 10796 PINES BLVD. #105
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-2129
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Country | US
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Telephone | 954-367-4888
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Fax | 954-367-4889
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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 | CH9276
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT19489
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License Number State | FL
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