Provider Demographics
NPI:1962541920
Name:GOULD, EDWARD IRA (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:IRA
Last Name:GOULD
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 1:9707 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6130
Mailing Address - Country:US
Mailing Address - Phone:513-791-8110
Mailing Address - Fax:513-791-8113
Practice Address - Street 1:9707 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-6130
Practice Address - Country:US
Practice Address - Phone:513-791-8110
Practice Address - Fax:513-791-8113
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0965933Medicaid
OH0965933Medicaid