Provider Demographics
NPI:1477910743
Name:GOODMAN, ABBIE KATHLEEN (DC)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:KATHLEEN
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ABBIE
Other - Middle Name:KATHLEEN
Other - Last Name:SHADICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W3124 VAN ROY RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-3982
Mailing Address - Country:US
Mailing Address - Phone:920-882-4000
Mailing Address - Fax:920-882-1101
Practice Address - Street 1:W3124 VAN ROY RD
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-3982
Practice Address - Country:US
Practice Address - Phone:920-882-4000
Practice Address - Fax:920-882-1101
Is Sole Proprietor?:No
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor