Provider Demographics
NPI:1619922168
Name:GOODMAN, DAVID L (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
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 1:7256 RISING SUN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3948
Mailing Address - Country:US
Mailing Address - Phone:215-725-3979
Mailing Address - Fax:215-725-5146
Practice Address - Street 1:7256 RISING SUN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3948
Practice Address - Country:US
Practice Address - Phone:215-725-3979
Practice Address - Fax:215-725-5146
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007666L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1954945Medicaid
PA853138OtherBLUE CROSS BLUE SHIELD
PA34424OtherHEALTH PARTNERS
PA0777297000OtherPERSONAL CHOICE
PA0777297000OtherKEYSTONE HEALTH PLAN EAST
PA3503293OtherAETNA
PA0777297000OtherPERSONAL CHOICE
PAU81363Medicare UPIN