Provider Demographics
NPI:1841458460
Name:DR DAVID D GOODRICH CHIROPRACTOR
Entity type:Organization
Organization Name:DR DAVID D GOODRICH CHIROPRACTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOODRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-595-6594
Mailing Address - Street 1:9999 SW 72ND ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4663
Mailing Address - Country:US
Mailing Address - Phone:305-595-6594
Mailing Address - Fax:305-595-6617
Practice Address - Street 1:9999 SW 72ND ST STE 205
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4663
Practice Address - Country:US
Practice Address - Phone:305-595-6594
Practice Address - Fax:305-595-6617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7834111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53860ZMedicare PIN