Provider Demographics
NPI:1083750665
Name:GOODKIN, PAUL SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:SCOTT
Last Name:GOODKIN
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 1:2500 N FEDERAL HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1618
Mailing Address - Country:US
Mailing Address - Phone:954-202-9009
Mailing Address - Fax:954-563-3630
Practice Address - Street 1:2500 N FEDERAL HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33305-1618
Practice Address - Country:US
Practice Address - Phone:954-202-9009
Practice Address - Fax:954-563-3630
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53905ZMedicare PIN