Provider Demographics
NPI:1679831382
Name:GOODRICH, MATTHEW SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SCOTT
Last Name:GOODRICH
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 1:171 CANDICE CIR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9609
Mailing Address - Country:US
Mailing Address - Phone:412-651-3022
Mailing Address - Fax:541-826-2620
Practice Address - Street 1:1296 S SHASTA AVE
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-8521
Practice Address - Country:US
Practice Address - Phone:541-830-4325
Practice Address - Fax:541-826-2620
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500696480Medicaid
ORR184949Medicare PIN