Provider Demographics
NPI:1306969811
Name:GOETZ, DEREK CHARLES (DC)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:CHARLES
Last Name:GOETZ
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 1:1531 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-2849
Mailing Address - Country:US
Mailing Address - Phone:954-922-1970
Mailing Address - Fax:954-922-1973
Practice Address - Street 1:1531 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-2849
Practice Address - Country:US
Practice Address - Phone:954-922-1970
Practice Address - Fax:954-922-1973
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6252111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation