Provider Demographics
NPI:1912015801
Name:GOODSIR, MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:GOODSIR
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 1:45 BERKELEY RD
Mailing Address - Street 2:
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-1381
Mailing Address - Country:US
Mailing Address - Phone:610-687-1669
Mailing Address - Fax:
Practice Address - Street 1:45 BERKELEY RD
Practice Address - Street 2:
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1381
Practice Address - Country:US
Practice Address - Phone:610-687-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005779L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA805109Medicare PIN