Provider Demographics
NPI:1871595165
Name:GOBEN CHIROPRACTIC OFFICES, PLLC
Entity type:Organization
Organization Name:GOBEN CHIROPRACTIC OFFICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOBEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-366-7386
Mailing Address - Street 1:700 GAGEL AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4008
Mailing Address - Country:US
Mailing Address - Phone:502-366-7386
Mailing Address - Fax:502-366-2222
Practice Address - Street 1:700 GAGEL AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4008
Practice Address - Country:US
Practice Address - Phone:502-366-7386
Practice Address - Fax:502-366-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000221631OtherANTHEM
KY1131052OtherPASSPORT
KY85002103Medicaid
KY000000050861OtherANTHEM
KY1136138OtherPASSPORT
KY85041663Medicaid
KY350036040OtherUNITED RAILROAD MEDICARE
KY=========A12OtherANTHEM SENIOR
KY85041663Medicaid
KY=========A12OtherANTHEM SENIOR
KY0512205Medicare ID - Type Unspecified
KY0512201Medicare ID - Type Unspecified