Provider Demographics
NPI:1760771760
Name:WORMAN-GOODE, DARCY RAE (DC)
Entity Type:Individual
Prefix:DR
First Name:DARCY
Middle Name:RAE
Last Name:WORMAN-GOODE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DARCY
Other - Middle Name:RAE
Other - Last Name:WORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:501 CARROLL ST
Mailing Address - Street 2:SUITE 612
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2292
Mailing Address - Country:US
Mailing Address - Phone:402-621-0106
Mailing Address - Fax:
Practice Address - Street 1:501 CARROLL ST STE 612
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-8201
Practice Address - Country:US
Practice Address - Phone:817-348-8488
Practice Address - Fax:817-348-8448
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB144412Medicare PIN