Provider Demographics
NPI:1033500426
Name:GOODMAN FAMILY AND SPORTS CHIROPRACTIC
Entity Type:Organization
Organization Name:GOODMAN FAMILY AND SPORTS CHIROPRACTIC
Other - Org Name:GOOD2GO CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:GOODMAN
Authorized Official - Last Name:DC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-762-3312
Mailing Address - Street 1:36402 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1330
Mailing Address - Country:US
Mailing Address - Phone:727-722-7700
Mailing Address - Fax:
Practice Address - Street 1:36402 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1330
Practice Address - Country:US
Practice Address - Phone:727-722-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-07
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty