Provider Demographics
NPI:1215052899
Name:GOODE, JOHN KENT (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KENT
Last Name:GOODE
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 1:122 TIMBERHILL PL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1595
Mailing Address - Country:US
Mailing Address - Phone:919-929-3434
Mailing Address - Fax:
Practice Address - Street 1:122 TIMBERHILL PL
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1595
Practice Address - Country:US
Practice Address - Phone:919-929-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08243OtherBCBSOFNC
NC08243OtherBCBSOFNC