Provider Demographics
NPI:1821102997
Name:GOOD CHOICE CHIROPRACTIC,INC
Entity Type:Organization
Organization Name:GOOD CHOICE CHIROPRACTIC,INC
Other - Org Name:KINESIOLOGY OF KANSAS & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:BS, DC
Authorized Official - Phone:620-356-1029
Mailing Address - Street 1:113 S MAIN ST.
Mailing Address - Street 2:SUITE C
Mailing Address - City:ULYSSES
Mailing Address - State:KS
Mailing Address - Zip Code:67880-2519
Mailing Address - Country:US
Mailing Address - Phone:620-356-1029
Mailing Address - Fax:620-424-1397
Practice Address - Street 1:113 S MAIN ST.
Practice Address - Street 2:SUITE C
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-2519
Practice Address - Country:US
Practice Address - Phone:620-356-1029
Practice Address - Fax:620-424-1397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04515111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060044Medicare ID - Type Unspecified
KSU4653Medicare UPIN