MEDICARE: DR. MARTIN JOHN GOULOOZE D.C.

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	3688	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ152098	OTHER	AZ	MEDICARE

General Provider Information

NPI Number	:	1700915519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN JOHN GOULOOZE D.C.

Provider Business Mailing Address
First Line	:	13925 W MEEKER BLVD STE 7
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85375-4431
Country	:	US
Telephone Number	:	602-618-0444
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 MCCULLOCH BLVD N STE C5
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5798
Country	:	US
Telephone Number	:	928-855-1220
Fax Number	:	928-855-1221

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	06/30/2022

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Directions to “ DR. MARTIN JOHN GOULOOZE D.C.” Practice Location

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