MEDICARE: GOHL CLINIC OF CHIROPRACTIC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	31280	CA

General Provider Information

NPI Number	:	1700297512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOHL CLINIC OF CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	2562 STATE ST
Second Line	:	SUITE B
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1663
Country	:	US
Telephone Number	:	760-729-8802
Fax Number	:

Provider Business Practice Location Address
First Line	:	2562 STATE ST
Second Line	:	SUITE B
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1663
Country	:	US
Telephone Number	:	760-729-8802
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSEPH P KAMETZ
Credential	:	DC
Telephone Number	:	760-729-8802

Provider Enumeration Date	:	05/14/2014
Last Update Date	:	05/14/2014

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