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General NPI Number Information
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NPI Number | 1700915519
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Entity Type | Individual
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Provider Name | MARTIN JOHN GOULOOZE D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 1850 MCCULLOCH BLVD N STE C5
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5798
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Country | US
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Telephone | 928-855-1220
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Fax | 928-855-1221
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Provider Business Mailing Address
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Address Line | 13925 W MEEKER BLVD STE 7
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City | SUN CITY
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State | AZ
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Zip | 85375-4431
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Country | US
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Telephone | 602-618-0444
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Fax |
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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 | 3688
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License Number State | AZ
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