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General NPI Number Information
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NPI Number | 1912046889
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Entity Type | Individual
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Provider Name | JASON COREY GOODMAN D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 27 WALNUT KNOLL CT
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City | SAINT CHARLES
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State | MO
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Zip | 63304-4549
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Country | US
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Telephone | 636-244-2250
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8343
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City | CHESTERFIELD
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State | MO
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Zip | 63017
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Country | US
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Telephone | 314-629-5794
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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 | 006691
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License Number State | MO
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