Healthcare Provider Details

I. General information

NPI: 1013168228
Provider Name (Legal Business Name): GOODE CHIROPRACTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 E 3RD ST
BLOOMINGTON IN
47401-5550
US

IV. Provider business mailing address

4211 E 3RD ST
BLOOMINGTON IN
47401-5550
US

V. Phone/Fax

Practice location:
  • Phone: 812-323-0700
  • Fax:
Mailing address:
  • Phone: 812-323-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002366A
License Number StateIN

VIII. Authorized Official

Name: DR. ROBERT J. GOODE III
Title or Position: OWNER
Credential:
Phone: 678-357-2628