Provider Demographics
NPI:1851893689
Name:GOOD, MIRANDA (DC)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:GOOD
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 1:215 NW 18TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4282
Mailing Address - Country:US
Mailing Address - Phone:515-964-1090
Mailing Address - Fax:
Practice Address - Street 1:215 NW 18TH ST STE 101
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4282
Practice Address - Country:US
Practice Address - Phone:515-964-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA815290526OtherTAX ID