Provider Demographics
NPI: | 1336173665 |
---|---|
Name: | TIMOTHY G. GOOD, D.C. |
Entity Type: | Organization |
Organization Name: | TIMOTHY G. GOOD, D.C. |
Other - Org Name: | GOOD CHIROPRACTIC CENTER |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | TIMOTHY |
Authorized Official - Middle Name: | GREGORY |
Authorized Official - Last Name: | GOOD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 814-825-4805 |
Mailing Address - Street 1: | 3813 DEXTER AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | ERIE |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 16504-2433 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 814-825-4805 |
Mailing Address - Fax: | 814-825-3144 |
Practice Address - Street 1: | 3813 DEXTER AVE |
Practice Address - Street 2: | |
Practice Address - City: | ERIE |
Practice Address - State: | PA |
Practice Address - Zip Code: | 16504-2433 |
Practice Address - Country: | US |
Practice Address - Phone: | 814-825-4805 |
Practice Address - Fax: | 814-825-3144 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-11 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | DC-0001954-L | 261Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center |