Healthcare Provider Details

I. General information

NPI: 1629345616
Provider Name (Legal Business Name): GOODWIN CHIROPRACTIC & ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2011
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12171 W PARMER LN SUITE 203
CEDAR PARK TX
78613-7361
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number11476
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID JAMES GOODWIN JR.
Title or Position: OWNER/DOCTOR
Credential: D.C.
Phone: 512-588-1501