Provider Demographics
NPI:1124385844
Name:GOODMAN, ERIC WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WAYNE
Last Name:GOODMAN
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 1:4805 PARK RD
Mailing Address - Street 2:STE 225
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3809
Mailing Address - Country:US
Mailing Address - Phone:704-956-1107
Mailing Address - Fax:704-987-3991
Practice Address - Street 1:18047 W CATAWBA AVE STE A
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5663
Practice Address - Country:US
Practice Address - Phone:704-956-1107
Practice Address - Fax:704-987-3991
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor