=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730420498
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOINS FAMILY CHIROPRACTIC SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2013
-----------------------------------------------------
Last Update Date | 03/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3275 BABCOCK BLVD
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15237-2828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-367-1555
-----------------------------------------------------
Fax | 412-367-1544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 804 MONTCLAIR DR
-----------------------------------------------------
City | NEW KENSINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15068-6866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-367-1555
-----------------------------------------------------
Fax | 412-367-1544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RICKY R GOINS JR.
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 315-729-1986
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC009846
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------