Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 5046 | OR |
NPI | 1043571136 |
---|---|
Provider Name | Dr. Adam Goulet |
First Address | Vancouver, WA 98684-5113 |
Second Address | Portland, OR 97217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2012 |
Last Update Date | 05/06/2012 |