Provider Demographics
NPI:1154403384
Name:GOODMAN, LISA KINGSBURY (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:KINGSBURY
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 S. CLARKSON ST.
Mailing Address - Street 2:UNIT
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2284
Mailing Address - Country:US
Mailing Address - Phone:303-744-7100
Mailing Address - Fax:303-744-7109
Practice Address - Street 1:1313 S. CLARKSON ST.
Practice Address - Street 2:UNIT 1
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2284
Practice Address - Country:US
Practice Address - Phone:303-744-7100
Practice Address - Fax:303-744-7109
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-5976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor