Provider Demographics
NPI:1437278272
Name:GOODE, GARY ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALLEN
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 1:4968 WILLIAM ARNOLD RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4238
Mailing Address - Country:US
Mailing Address - Phone:901-685-1356
Mailing Address - Fax:901-767-6223
Practice Address - Street 1:4954 WILLIAM ARNOLD RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4238
Practice Address - Country:US
Practice Address - Phone:901-685-1356
Practice Address - Fax:901-767-6223
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1195111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3029427OtherBLUE CROSS BLUE SHIELD ID
TN8567089OtherCIGNA ID NUMBER
TN5926030OtherAETNA ID NUMBER
TN5926030OtherAETNA ID NUMBER
TNU53337Medicare UPIN