Provider Demographics
NPI:1548592074
Name:GOODSPEED, JULIE DIANE (DC)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:DIANE
Last Name:GOODSPEED
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 RED TAIL RD STE 9
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1582
Mailing Address - Country:US
Mailing Address - Phone:716-677-4300
Mailing Address - Fax:716-434-3868
Practice Address - Street 1:240 RED TAIL RD STE 9
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1582
Practice Address - Country:US
Practice Address - Phone:716-677-4300
Practice Address - Fax:716-434-3868
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70011958111NP0017X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor