Provider Demographics
NPI:1033171855
Name:GOOD, TIMOTHY GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GREGORY
Last Name:GOOD
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 1:3813 DEXTER AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-2433
Mailing Address - Country:US
Mailing Address - Phone:814-825-4805
Mailing Address - Fax:814-825-3144
Practice Address - Street 1:3813 DEXTER AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-2433
Practice Address - Country:US
Practice Address - Phone:814-825-4805
Practice Address - Fax:814-825-3144
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-001954-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT300007Medicare UPIN