MEDICARE: SEMYON GOFMAN 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	305S00000X	Point of Service	DC26055	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780885251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEMYON GOFMAN CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	1191 N VERMONT AVE STE B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1701
Country	:	US
Telephone Number	:	323-668-1535
Fax Number	:	323-668-0666

Provider Business Practice Location Address
First Line	:	1191 N VERMONT AVE STE B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1701
Country	:	US
Telephone Number	:	323-668-1535
Fax Number	:	323-668-0666

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SEMYON M GOFMAN
Credential	:	CHIROPRACTOR
Telephone Number	:	323-668-1535

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	08/22/2020

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