Provider Demographics
NPI:1134565005
Name:GOODE CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:GOODE CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-259-8888
Mailing Address - Street 1:1300 CROTON RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3164
Mailing Address - Country:US
Mailing Address - Phone:321-259-8888
Mailing Address - Fax:321-254-6555
Practice Address - Street 1:1300 CROTON RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3164
Practice Address - Country:US
Practice Address - Phone:321-259-8888
Practice Address - Fax:321-254-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0001214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty