MEDICARE: DR. SYDNEY GOODIJOHN

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	CH11296	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902283138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SYDNEY GOODIJOHN

Provider Business Mailing Address
First Line	:	1343 S INTERNATIONAL PKWY
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-1401
Country	:	US
Telephone Number	:	407-792-0705
Fax Number	:	407-792-0710

Provider Business Practice Location Address
First Line	:	1343 S INTERNATIONAL PKWY
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-1401
Country	:	US
Telephone Number	:	407-792-0705
Fax Number	:

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

Provider Enumeration Date	:	04/27/2015
Last Update Date	:	03/30/2023

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