=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104923788
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TODD C. GOODALE D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1833 EL DORADO BLVD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77062-3601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-480-7784
-----------------------------------------------------
Fax | 281-480-7565
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1833 EL DORADO BLVD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77062-3601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-480-7784
-----------------------------------------------------
Fax | 281-480-7565
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NX0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Chiropractor
-----------------------------------------------------
License Number | 4231
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------