Provider Demographics
NPI:1831461037
Name:R. PETER GOODFIELD, D.C., P.C.
Entity Type:Organization
Organization Name:R. PETER GOODFIELD, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:GOODFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-825-8867
Mailing Address - Street 1:605 OLD BRANDY RD
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-2825
Mailing Address - Country:US
Mailing Address - Phone:540-825-8867
Mailing Address - Fax:540-825-0022
Practice Address - Street 1:605 OLD BRANDY RD
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-2825
Practice Address - Country:US
Practice Address - Phone:540-825-8867
Practice Address - Fax:540-825-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01044000150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350915310Medicare PIN