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General NPI Number Information
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NPI Number | 1245445220
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Entity Type | Organization
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Legal Business Name | GOODMAN CHIROPRACTIC PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 425 LOMBARD ST
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-5898
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Country | US
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Telephone | 805-495-2735
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Fax |
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Provider Business Mailing Address
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Address Line | 425 LOMBARD ST
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-5898
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Country | US
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Telephone | 805-495-2735
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MRS. GERALDINE B. GOODMAN
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Credential |
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Telephone | 805-495-2735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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