MEDICARE: WILLIAM JOHN GOLAS DC

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	2301006669	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950A15030	OTHER	MI	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952329005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM JOHN GOLAS DC

Provider Business Mailing Address
First Line	:	64060 66TH AVE
Second Line	:
City	:	HARTFORD
State	:	MI
Zip	:	49057-9692
Country	:	US
Telephone Number	:	269-208-3122
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 E NAPIER AVE
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-2136
Country	:	US
Telephone Number	:	269-926-8213
Fax Number	:	269-926-8215

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	10/06/2011

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