Provider Demographics
NPI:1851027833
Name:GODDARD, RACHAEL (DC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:GODDARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 EDEN AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2368
Mailing Address - Country:US
Mailing Address - Phone:952-920-9721
Mailing Address - Fax:
Practice Address - Street 1:5201 EDEN AVE STE 190
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-2368
Practice Address - Country:US
Practice Address - Phone:952-920-9721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor