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General NPI Number Information
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NPI Number | 1891393872
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE CHIROPRACTIC AND REHAB CENTER, LLC
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Dates
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Enumeration Date | 10/13/2020
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 4075 PINE RIDGE RD STE 8
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City | NAPLES
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State | FL
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Zip | 34119-4004
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Country | US
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Telephone | 239-325-9640
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Fax | 239-431-6782
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Provider Business Mailing Address
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Address Line | 4075 PINE RIDGE RD STE 8
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City | NAPLES
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State | FL
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Zip | 34119-4004
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Country | US
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Telephone | 239-325-9640
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Fax | 239-431-6782
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. JOHN DAVID GOOLSBY
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Credential | DC
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Telephone | 864-350-5974
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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 |
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License Number State |
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