Provider Demographics
NPI:1194780601
Name:GOOLSBY, JOHN DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:GOOLSBY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 FLORIDA CIR S
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2531
Mailing Address - Country:US
Mailing Address - Phone:864-350-5974
Mailing Address - Fax:
Practice Address - Street 1:556 FLORIDA CIR S
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2531
Practice Address - Country:US
Practice Address - Phone:864-350-5974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10161111N00000X
SC3001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB04885Medicare UPIN
SCAA08478423Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER