Provider Demographics
NPI:1821013848
Name:GOODMAN, CHARLES DEHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DEHARD
Last Name:GOODMAN
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 1:751 BLOSSOM HILL RD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3583
Mailing Address - Country:US
Mailing Address - Phone:408-358-8180
Mailing Address - Fax:408-356-8214
Practice Address - Street 1:751 BLOSSOM HILL RD
Practice Address - Street 2:SUITE A1
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3583
Practice Address - Country:US
Practice Address - Phone:408-358-8180
Practice Address - Fax:408-356-8214
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25059111N00000X
HIDC-1062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0250590Medicare ID - Type Unspecified