Provider Demographics
NPI:1891128237
Name:ROBERT H GOECKEL DC LLC
Entity type:Organization
Organization Name:ROBERT H GOECKEL DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOECKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-736-0501
Mailing Address - Street 1:4306 RICHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-2022
Mailing Address - Country:US
Mailing Address - Phone:810-736-0501
Mailing Address - Fax:810-736-4783
Practice Address - Street 1:4306 RICHFIELD RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-2022
Practice Address - Country:US
Practice Address - Phone:810-736-0501
Practice Address - Fax:810-736-4783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B50891OtherBCBS
MI1658358Medicaid
MI350039013OtherPALMETTO RR MEDICARE
MI0B50891OtherMEDICARE PTIN
MIP73506OtherBLUE CARE NET NUMBER
MIXX05374OtherHEALTH PLUS PROVIDER CODE
MIXX05374OtherHEALTH PLUS PROVIDER CODE