Provider Demographics
NPI:1467760603
Name:GODWIN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:GODWIN CHIROPRACTIC LLC
Other - Org Name:GODWIN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-239-3042
Mailing Address - Street 1:1139 COLONNADE CTR
Mailing Address - Street 2:
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4328
Mailing Address - Country:US
Mailing Address - Phone:314-239-3042
Mailing Address - Fax:
Practice Address - Street 1:1139 COLONNADE CTR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-4328
Practice Address - Country:US
Practice Address - Phone:314-239-3042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009024561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty