MEDICARE: MATTHEW DAVID GOODWIN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	006474	MO

General Provider Information

NPI Number	:	1265562540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW DAVID GOODWIN D.C.

Provider Business Mailing Address
First Line	:	2682 BABBLE CREEK LN
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63368-8337
Country	:	US
Telephone Number	:	636-978-3000
Fax Number	:	636-978-1821

Provider Business Practice Location Address
First Line	:	2682 BABBLE CREEK LN
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63368-8337
Country	:	US
Telephone Number	:	636-978-3000
Fax Number	:	636-978-1821

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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