Active NPI
Harold John Goebel Jr., D.C.
- Chiropractor
- Fort Wayne, IN
National Provider Identifier
1942264007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 08001017A
- Practice address
- 4309 W Jefferson Blvd
Fort Wayne, IN 46804-6819 - Phone
- (260) 436-3783
- Fax
- (260) 432-2330
- NPI assigned
- Apr 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 08001017A | IN | Primary |
Addresses
Primary practice location
4309 W Jefferson Blvd
Fort Wayne, IN 46804-6819
Mailing address
4309 W Jefferson Blvd
Fort Wayne, IN 46804-6819
Phone (260) 436-3783
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000087061 | Other | IN | BLUE CROSS AND BLUE SHIEL |
| 4351502 | Other | IN | AETNA INS. NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08001017A | IN | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1942264007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4309 W JEFFERSON BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468046819",
"telephone_number": "260-436-3783",
"fax_number": "260-432-2330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4309 W JEFFERSON BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468046819",
"telephone_number": "260-436-3783",
"fax_number": "260-432-2330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOEBEL",
"first_name": "HAROLD",
"middle_name": "JOHN",
"name_suffix": "Jr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IN",
"license": "08001017A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS AND BLUE SHIEL",
"identifier": "000000087061",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA INS. NUMBER",
"identifier": "4351502",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.