Healthcare Provider Details

I. General information

NPI: 1033496229
Provider Name (Legal Business Name): ALLIE DAY GOODWIN D.C., DIPL.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12171 W PARMER LN SUITE 203
CEDAR PARK TX
78613-7549
US

IV. Provider business mailing address

12171 W PARMER LN SUITE 203
CEDAR PARK TX
78613-7549
US

V. Phone/Fax

Practice location:
  • Phone: 512-588-1501
  • Fax: 512-588-1502
Mailing address:
  • Phone: 512-588-1501
  • Fax: 512-588-1502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11447
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number11447
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: