Provider Demographics
NPI:1295862118
Name:GOODWIN, JEFFREY G (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:G
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1223 W MCDERMOTT DR
Mailing Address - Street 2:SUITE 70
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6412
Mailing Address - Country:US
Mailing Address - Phone:214-547-1336
Mailing Address - Fax:214-547-0131
Practice Address - Street 1:1223 W MCDERMOTT DR
Practice Address - Street 2:SUITE 70
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6412
Practice Address - Country:US
Practice Address - Phone:214-547-1336
Practice Address - Fax:214-547-0131
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor