=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336173665
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TIMOTHY G. GOOD, D.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3813 DEXTER AVE
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16504-2433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-825-4805
-----------------------------------------------------
Fax | 814-825-3144
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3813 DEXTER AVE
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16504-2433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-825-4805
-----------------------------------------------------
Fax | 814-825-3144
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. TIMOTHY GREGORY GOOD
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 814-825-4805
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | DC-0001954-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------