Provider Demographics
NPI:1467984740
Name:GOODWIN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:GOODWIN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-952-6567
Mailing Address - Street 1:4130 LINDEN AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-3073
Mailing Address - Country:US
Mailing Address - Phone:937-952-6567
Mailing Address - Fax:937-660-4066
Practice Address - Street 1:4130 LINDEN AVE STE 125
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3073
Practice Address - Country:US
Practice Address - Phone:937-952-6567
Practice Address - Fax:937-660-4066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty