Provider Demographics
NPI:1104923788
Name:GOODALE, TODD C (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:C
Last Name:GOODALE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 EL DORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-3601
Mailing Address - Country:US
Mailing Address - Phone:281-480-7784
Mailing Address - Fax:281-480-7565
Practice Address - Street 1:1833 EL DORADO BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-3601
Practice Address - Country:US
Practice Address - Phone:281-480-7784
Practice Address - Fax:281-480-7565
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4231111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601584OtherBCBS
TX601584Medicare ID - Type Unspecified
TX601584OtherBCBS