MEDICARE: DR. DAVID R GOOLDY 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	2108	SC

General Provider Information

NPI Number	:	1972590040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID R GOOLDY DC

Provider Business Mailing Address
First Line	:	PO BOX 84428
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-0008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1926 S LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-8282
Country	:	US
Telephone Number	:	803-808-1897
Fax Number	:

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	08/24/2007

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Directions to “ DR. DAVID R GOOLDY DC” Practice Location

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