Provider Demographics
NPI:1629345616
Name:GOODWIN CHIROPRACTIC & ACUPUNCTURE
Entity Type:Organization
Organization Name:GOODWIN CHIROPRACTIC & ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:512-588-1501
Mailing Address - Street 1:12171 W. PARMER LN,
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12171 W PARMER LN
Practice Address - Street 2:SUITE 203
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7361
Practice Address - Country:US
Practice Address - Phone:512-588-1501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
TX11476171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty