Provider Demographics
NPI:1447260559
Name:GOLDSTEIN, LARRY S (DC)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:S
Last Name:GOLDSTEIN
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 1:4640 VALAIS CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-2606
Mailing Address - Country:US
Mailing Address - Phone:770-667-0018
Mailing Address - Fax:770-667-6393
Practice Address - Street 1:4640 VALAIS CT
Practice Address - Street 2:SUITE 100
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-2606
Practice Address - Country:US
Practice Address - Phone:770-667-0018
Practice Address - Fax:770-667-6393
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor