Provider Demographics
NPI:1790286920
Name:GOODMAN, JULIA MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:MICHELLE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:MICHELLE
Other - Last Name:CULBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:99-080 KAUHALE ST STE D9
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4114
Mailing Address - Country:US
Mailing Address - Phone:808-452-1890
Mailing Address - Fax:
Practice Address - Street 1:99-080 KAUHALE ST STE D9
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4114
Practice Address - Country:US
Practice Address - Phone:808-452-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC34118111N00000X
HI1502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty