Provider Demographics
NPI:1366614398
Name:GOLDYCH, MICHELLE C (DC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:GOLDYCH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13108-1118
Mailing Address - Country:US
Mailing Address - Phone:315-288-3633
Mailing Address - Fax:315-699-2596
Practice Address - Street 1:6 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARCELLUS
Practice Address - State:NY
Practice Address - Zip Code:13108-1118
Practice Address - Country:US
Practice Address - Phone:315-288-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXO11536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ300057708Medicare PIN