Provider Demographics
NPI:1376759217
Name:GOODE, GREGORY DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DALE
Last Name:GOODE
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 1:720 ORA DELL AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2247
Mailing Address - Country:US
Mailing Address - Phone:321-268-1537
Mailing Address - Fax:
Practice Address - Street 1:1300 CROTON RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3164
Practice Address - Country:US
Practice Address - Phone:321-259-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0003036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor