Provider Demographics
NPI:1124419072
Name:GOODELL, DAVID (MAC, DIPL AC LAC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GOODELL
Suffix:
Gender:M
Credentials:MAC, DIPL AC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 QUEEN ANNE AVE N APT 100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2878
Mailing Address - Country:US
Mailing Address - Phone:206-298-9376
Mailing Address - Fax:
Practice Address - Street 1:1529 QUEEN ANNE AVE N APT 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2878
Practice Address - Country:US
Practice Address - Phone:206-298-9376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 00002771171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist