Provider Demographics
NPI:1609983956
Name:GOECKE, MARIAH ANN (DC)
Entity type:Individual
Prefix:DR
First Name:MARIAH
Middle Name:ANN
Last Name:GOECKE
Suffix:
Gender:F
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:W61N306 WASHINGTON AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2451
Mailing Address - Country:US
Mailing Address - Phone:262-951-5189
Mailing Address - Fax:262-240-1602
Practice Address - Street 1:10532 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5563
Practice Address - Country:US
Practice Address - Phone:262-240-1600
Practice Address - Fax:262-240-1602
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4127-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38967200Medicaid
WI000135796Medicare ID - Type Unspecified
WIV07267Medicare UPIN