Provider Demographics
NPI:1790017770
Name:HOLLY GOODWIN, LLC
Entity Type:Organization
Organization Name:HOLLY GOODWIN, LLC
Other - Org Name:GOODWIN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-542-0058
Mailing Address - Street 1:1111 DRAPER PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9044
Mailing Address - Country:US
Mailing Address - Phone:801-542-0058
Mailing Address - Fax:801-542-0062
Practice Address - Street 1:1111 DRAPER PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9044
Practice Address - Country:US
Practice Address - Phone:801-542-0058
Practice Address - Fax:801-542-0062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3583261202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty