Provider Demographics
NPI:1770541047
Name:GOLDSCHLAGER, JEFFREY (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:GOLDSCHLAGER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 KING ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4479
Mailing Address - Country:US
Mailing Address - Phone:860-583-5454
Mailing Address - Fax:860-589-4654
Practice Address - Street 1:775 KING ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4479
Practice Address - Country:US
Practice Address - Phone:860-583-5454
Practice Address - Fax:860-589-4654
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT792712OtherAETNA
CT050000281CT02OtherANTHEM BLUE CROSS
CT792712OtherAETNA