Provider Demographics
NPI:1245445220
Name:GOODMAN CHIROPRACTIC PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:GOODMAN CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-495-2735
Mailing Address - Street 1:425 LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5898
Mailing Address - Country:US
Mailing Address - Phone:805-495-2735
Mailing Address - Fax:
Practice Address - Street 1:425 LOMBARD ST
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5898
Practice Address - Country:US
Practice Address - Phone:805-495-2735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty