Provider Demographics
NPI:1720478787
Name:MAGGIE GOODYEAR INC.
Entity Type:Organization
Organization Name:MAGGIE GOODYEAR INC.
Other - Org Name:GOODYEAR WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODYEAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-441-8447
Mailing Address - Street 1:912 DREW ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-4550
Mailing Address - Country:US
Mailing Address - Phone:727-441-8447
Mailing Address - Fax:727-462-2961
Practice Address - Street 1:912 DREW ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-4550
Practice Address - Country:US
Practice Address - Phone:727-441-8447
Practice Address - Fax:727-462-2961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty