Provider Demographics
NPI:1376712976
Name:GOODWIN CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:GOODWIN CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC - CHIROPRACTOR
Authorized Official - Phone:925-287-0130
Mailing Address - Street 1:1800 OAK PARK BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4479
Mailing Address - Country:US
Mailing Address - Phone:925-287-0130
Mailing Address - Fax:925-287-4637
Practice Address - Street 1:1800 OAK PARK BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4479
Practice Address - Country:US
Practice Address - Phone:925-287-0130
Practice Address - Fax:925-287-4637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADL883AMedicare PIN