Provider Demographics
NPI:1679625719
Name:GOLDFELDT, JOHN PHILLIP (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PHILLIP
Last Name:GOLDFELDT
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 1:826 N MULLAN RD
Mailing Address - Street 2:B
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4094
Mailing Address - Country:US
Mailing Address - Phone:509-928-8550
Mailing Address - Fax:509-928-8592
Practice Address - Street 1:826 N MULLAN RD
Practice Address - Street 2:B
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4094
Practice Address - Country:US
Practice Address - Phone:509-928-8550
Practice Address - Fax:509-928-8592
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003671111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB13166Medicare ID - Type Unspecified