Provider Demographics
NPI:1104711035
Name:GOODIER, KYLE WOLFGANG (DC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:WOLFGANG
Last Name:GOODIER
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 1:2008 VICKIE DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-3650
Mailing Address - Country:US
Mailing Address - Phone:469-332-8454
Mailing Address - Fax:
Practice Address - Street 1:6301 GASTON AVE STE 1104
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3954
Practice Address - Country:US
Practice Address - Phone:469-909-3669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor