Provider Demographics
NPI:1558808659
Name:GODWIN, ANDREW ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ALLEN
Last Name:GODWIN
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 1:29G MIRACLE STRIP PKWY SW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-6655
Mailing Address - Country:US
Mailing Address - Phone:850-374-3926
Mailing Address - Fax:
Practice Address - Street 1:29G MIRACLE STRIP PKWY SW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-6655
Practice Address - Country:US
Practice Address - Phone:334-437-4308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor