Provider Demographics
NPI:1801270012
Name:GOODE, MATTHEW DALE (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DALE
Last Name:GOODE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 JEB STUART DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2118
Mailing Address - Country:US
Mailing Address - Phone:407-760-5501
Mailing Address - Fax:
Practice Address - Street 1:117 JEB STUART DR
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2118
Practice Address - Country:US
Practice Address - Phone:407-760-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor