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General NPI Number Information
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NPI Number | 1790883577
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Entity Type | Organization
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Legal Business Name | GOODWIN CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 1018 BROAD ST
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City | SUMMERSVILLE
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State | WV
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Zip | 26651-1711
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Country | US
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Telephone | 304-872-1006
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Fax | 304-872-5994
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Provider Business Mailing Address
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Address Line | 1018 BROAD ST
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City | SUMMERSVILLE
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State | WV
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Zip | 26651-1711
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Country | US
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Telephone | 304-872-1006
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Fax | 304-872-5994
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. THOMAS GOODWIN
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Credential | D.C.
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Telephone | 304-872-1006
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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 | 775
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License Number State | WV
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