Provider Demographics
NPI:1568973428
Name:GOODMAN, ZACHARY BRYEN (DC)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:BRYEN
Last Name:GOODMAN
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 1:1061 N DOBSON RD STE 110
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-7577
Mailing Address - Country:US
Mailing Address - Phone:856-534-0872
Mailing Address - Fax:
Practice Address - Street 1:1061 N DOBSON RD STE 110
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-7577
Practice Address - Country:US
Practice Address - Phone:856-534-0872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor