Provider Demographics
NPI:1881489540
Name:GOODWIN, KATHLEEN (DC)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4508 NORBECK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-1707
Mailing Address - Country:US
Mailing Address - Phone:301-525-3569
Mailing Address - Fax:
Practice Address - Street 1:1010 ROCKVILLE PIKE STE 308
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1495
Practice Address - Country:US
Practice Address - Phone:240-624-2949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS04242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor