Provider Demographics
NPI:1164438917
Name:GOODEN, ROBIN WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:WILLIAM
Last Name:GOODEN
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 1:16 PENN PLZ
Mailing Address - Street 2:STE 22
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3620
Mailing Address - Country:US
Mailing Address - Phone:207-947-8077
Mailing Address - Fax:207-947-3721
Practice Address - Street 1:16 PENN PLZ
Practice Address - Street 2:STE 22
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3620
Practice Address - Country:US
Practice Address - Phone:207-947-8077
Practice Address - Fax:207-947-3721
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME170220000Medicaid
ME170220000Medicaid