Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CH9067 | FL |
Y | 111NR0400X | Rehabilitation Chiropractor | CH9067 | FL |
NPI | 1366646655 |
---|---|
Provider Name | Dr. Dennis C Gouldbourne |
First Address | Miramar, FL 33023-5820 |
Second Address | Miramar, FL 33027-4572 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2007 |
Last Update Date | 13/04/2009 |