Provider Demographics
NPI:1033616438
Name:GOODMAN, DANIEL YALE
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:YALE
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2372 SAINT CLAUDE AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-8388
Mailing Address - Country:US
Mailing Address - Phone:516-567-6989
Mailing Address - Fax:
Practice Address - Street 1:2372 SAINT CLAUDE AVE STE 220
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-8388
Practice Address - Country:US
Practice Address - Phone:516-567-6989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty