Provider Demographics
NPI:1336472794
Name:GOEDKEN, MATTHEW J (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:GOEDKEN
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 1:1702 EAGAN RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3702
Mailing Address - Country:US
Mailing Address - Phone:608-243-1234
Mailing Address - Fax:
Practice Address - Street 1:1702 EAGAN RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3702
Practice Address - Country:US
Practice Address - Phone:608-243-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4540 12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor