Provider Demographics
NPI:1225056799
Name:GOOD, PATRICK A (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:A
Last Name:GOOD
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 1:14010 ROUTE 8 & 89
Mailing Address - Street 2:
Mailing Address - City:WATTSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16442-9760
Mailing Address - Country:US
Mailing Address - Phone:814-739-2775
Mailing Address - Fax:814-739-2606
Practice Address - Street 1:14010 ROUTE 8 & 89
Practice Address - Street 2:
Practice Address - City:WATTSBURG
Practice Address - State:PA
Practice Address - Zip Code:16442-9760
Practice Address - Country:US
Practice Address - Phone:814-739-2775
Practice Address - Fax:814-739-2606
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001443L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006343980002Medicaid
107167OtherBCBS
107167Medicare ID - Type Unspecified
T28707Medicare UPIN