Provider Demographics
NPI:1518430040
Name:GOODPASTER, BRANDON (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:GOODPASTER
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 1:352 OLD GALLATIN RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-8666
Mailing Address - Country:US
Mailing Address - Phone:270-237-3304
Mailing Address - Fax:270-237-3305
Practice Address - Street 1:760 CAMPBELL LN STE 120
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1085
Practice Address - Country:US
Practice Address - Phone:270-237-3304
Practice Address - Fax:270-237-3305
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5591OtherSTATE OF KY CHIROPRACTIC LICENSE