Provider Demographics
NPI:1124216635
Name:GOODSON, JENNI COOPER (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNI
Middle Name:COOPER
Last Name:GOODSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3842 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-4202
Mailing Address - Country:US
Mailing Address - Phone:205-447-0401
Mailing Address - Fax:
Practice Address - Street 1:140 VILLAGE ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6452
Practice Address - Country:US
Practice Address - Phone:205-447-0401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2216111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor