Provider Demographics
NPI:1720612021
Name:GODARD CHIROPRACTIC
Entity Type:Organization
Organization Name:GODARD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:GODARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-695-0665
Mailing Address - Street 1:2812 N NORWALK STE 122
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1149
Mailing Address - Country:US
Mailing Address - Phone:480-844-7900
Mailing Address - Fax:480-699-4281
Practice Address - Street 1:2812 N NORWALK STE 122
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1149
Practice Address - Country:US
Practice Address - Phone:480-844-7900
Practice Address - Fax:480-699-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty