Provider Demographics
NPI:1063921674
Name:GOETSCH, MICHAEL LEONARD (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEONARD
Last Name:GOETSCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:GOETSCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2085 CRAMER CIR APT 303
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7860
Mailing Address - Country:US
Mailing Address - Phone:850-776-3237
Mailing Address - Fax:
Practice Address - Street 1:434 N TRADE ST # 103
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1864
Practice Address - Country:US
Practice Address - Phone:850-776-3237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty