Provider Demographics
NPI:1841478708
Name:MATTHEW W. GODWIN, D.C., P.A.
Entity type:Organization
Organization Name:MATTHEW W. GODWIN, D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:W
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-810-2689
Mailing Address - Street 1:33125 SAINT JOE RD
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-0300
Mailing Address - Country:US
Mailing Address - Phone:813-810-2689
Mailing Address - Fax:
Practice Address - Street 1:5346 8TH ST
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-4336
Practice Address - Country:US
Practice Address - Phone:813-782-1316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-03
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007983200Medicaid
FL007983200Medicaid