MEDICARE: GOOD CHOICE CHIROPRACTIC,INC

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	01-04515	KS

General Provider Information

NPI Number	:	1821102997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD CHOICE CHIROPRACTIC,INC

Provider Business Mailing Address
First Line	:	113 S MAIN ST.
Second Line	:	SUITE C
City	:	ULYSSES
State	:	KS
Zip	:	67880-2519
Country	:	US
Telephone Number	:	620-356-1029
Fax Number	:	620-424-1397

Provider Business Practice Location Address
First Line	:	113 S MAIN ST.
Second Line	:	SUITE C
City	:	ULYSSES
State	:	KS
Zip	:	67880-2519
Country	:	US
Telephone Number	:	620-356-1029
Fax Number	:	620-424-1397

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RANDALL J GOODWIN
Credential	:	BS, DC
Telephone Number	:	620-356-1029

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	02/15/2008

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Directions to “GOOD CHOICE CHIROPRACTIC,INC ” Practice Location

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