MEDICARE: DR. ZACHARY BRYEN GOODMAN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	8671	AZ

General Provider Information

NPI Number	:	1568973428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZACHARY BRYEN GOODMAN DC

Provider Business Mailing Address
First Line	:	1061 N DOBSON RD STE 110
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-7577
Country	:	US
Telephone Number	:	856-534-0872
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 N DOBSON RD STE 110
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-7577
Country	:	US
Telephone Number	:	856-534-0872
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2017
Last Update Date	:	01/25/2021

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