MEDICARE: JEANETTE GOODWILL

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	13585	TX

General Provider Information

NPI Number	:	1811484066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE GOODWILL

Provider Business Mailing Address
First Line	:	3852 TELEPHONE RD APT 5105
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-5756
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3852 TELEPHONE RD APT 5105
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-5756
Country	:	US
Telephone Number	:	832-816-1833
Fax Number	:

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

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	04/13/2018

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Directions to “ JEANETTE GOODWILL ” Practice Location

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