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General NPI Number Information
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NPI Number | 1669695326
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Entity Type | Organization
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Legal Business Name | EP GOSLINE CHIROPRACTIC CLINIC PA
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 235 CARL VINSON PKWY
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City | WARNER ROBINS
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State | GA
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Zip | 31088-5815
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Country | US
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Telephone | 478-923-5511
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Fax | 478-923-5509
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Provider Business Mailing Address
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Address Line | 235 CARL VINSON PKWY
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City | WARNER ROBINS
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State | GA
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Zip | 31088-5815
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Country | US
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Telephone | 478-923-5511
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Fax | 478-923-5509
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Authorized Official
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Title or Position | CEO
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Name | DR. GREGORY ALAN GOSLINE
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Credential | DC
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Telephone | 478-923-5511
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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 | CHIR001710
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License Number State | GA
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