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General NPI Number Information
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NPI Number | 1821013848
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Entity Type | Individual
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Provider Name | CHARLES DEHARD GOODMAN D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 751 BLOSSOM HILL RD SUITE A1
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City | LOS GATOS
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State | CA
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Zip | 95032-3583
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Country | US
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Telephone | 408-358-8180
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Fax | 408-356-8214
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Provider Business Mailing Address
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Address Line | 751 BLOSSOM HILL RD SUITE A1
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City | LOS GATOS
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State | CA
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Zip | 95032-3583
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Country | US
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Telephone | 408-358-8180
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Fax | 408-356-8214
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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 | DC25059
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC-1062
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License Number State | HI
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