Provider Demographics
NPI:1629178280
Name:GOODFIELD, RAYMOND PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:PETER
Last Name:GOODFIELD
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 1:605 OLD BRANDY RD
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-2825
Mailing Address - Country:US
Mailing Address - Phone:540-825-8867
Mailing Address - Fax:540-825-5032
Practice Address - Street 1:605 OLD BRANDY RD
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-2825
Practice Address - Country:US
Practice Address - Phone:540-825-8867
Practice Address - Fax:540-825-5032
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000150111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350915310Medicare ID - Type Unspecified
VAT21641Medicare UPIN