Provider Demographics
NPI:1649594698
Name:ELIZABETH ANN GOODMAN, D.C., L.L.C.
Entity type:Organization
Organization Name:ELIZABETH ANN GOODMAN, D.C., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LLC
Authorized Official - Phone:941-914-0023
Mailing Address - Street 1:16204 S. 4133 RD.
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017
Mailing Address - Country:US
Mailing Address - Phone:941-914-0023
Mailing Address - Fax:941-914-0023
Practice Address - Street 1:900 E WILL ROGERS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-6303
Practice Address - Country:US
Practice Address - Phone:941-914-0023
Practice Address - Fax:941-914-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty