Provider Demographics
NPI:1326071218
Name:GOAD, MICHAEL P (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:GOAD
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 1:2708 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5021
Mailing Address - Country:US
Mailing Address - Phone:903-526-2323
Mailing Address - Fax:903-526-2484
Practice Address - Street 1:2708 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-5021
Practice Address - Country:US
Practice Address - Phone:903-526-2323
Practice Address - Fax:903-526-2484
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F2341Medicare UPIN
TXU44331Medicare UPIN