Provider Demographics
NPI:1215077953
Name:GOODMAN, MARILYN F (DC)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:F
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:PO BOX 7891
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76714-7891
Mailing Address - Country:US
Mailing Address - Phone:254-776-1030
Mailing Address - Fax:254-732-3314
Practice Address - Street 1:7524 BOSQUE BLVD
Practice Address - Street 2:STE D
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3772
Practice Address - Country:US
Practice Address - Phone:254-776-1030
Practice Address - Fax:254-732-3314
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0015950 01Medicaid
TX83410XOtherBLUE CROSS ID NUMBER
TXU25140Medicare UPIN