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General NPI Number Information
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NPI Number | 1578814968
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Entity Type | Individual
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Provider Name | MATTHEW RYAN GOODRICH D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 01/29/2016
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Provider Practice Location Address
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Address Line | 1321 SE MARSHALL ST
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City | BOONE
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State | IA
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Zip | 50036-7519
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Country | US
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Telephone | 515-577-8932
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Fax |
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Provider Business Mailing Address
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Address Line | 917 S KENNEDY AVE TRLR 26
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City | MADRID
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State | IA
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Zip | 50156-9600
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Country | US
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Telephone | 515-577-8932
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 007540
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License Number State | IA
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