Provider Demographics
NPI:1447890637
Name:COMMUNITY CARE CHIROPRACTIC @ REHAB CENTER, LLC
Entity type:Organization
Organization Name:COMMUNITY CARE CHIROPRACTIC @ REHAB CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GOOLSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-720-6736
Mailing Address - Street 1:2781 FREEWAY BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-1765
Mailing Address - Country:US
Mailing Address - Phone:612-720-6736
Mailing Address - Fax:
Practice Address - Street 1:2781 FREEWAY BLVD STE 160
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-1765
Practice Address - Country:US
Practice Address - Phone:612-720-6736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty