Provider Demographics
NPI:1427112812
Name:GOLDEN, JOHN LEWIS (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEWIS
Last Name:GOLDEN
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 1:14824 LONG BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5409
Mailing Address - Country:US
Mailing Address - Phone:636-532-3030
Mailing Address - Fax:636-532-3733
Practice Address - Street 1:14824 LONG BRANCH CT
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5409
Practice Address - Country:US
Practice Address - Phone:636-532-3030
Practice Address - Fax:636-532-3733
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO44-00903OtherUNITED HEALTH CARE - OLD
MO236943OtherHEALTHLINK
MO5484OtherBLUE CROSS BLUE SHIELD
MO43-1841030OtherALL OTHERS
MO5871577OtherAETNA
MO44-00903OtherUNITED HEALTH CARE - OLD