Provider Demographics
NPI:1285694414
Name:GOODMAN, JAMIE ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:ALAN
Last Name:GOODMAN
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 1:2206 CURLEW RD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-6823
Mailing Address - Country:US
Mailing Address - Phone:727-772-7788
Mailing Address - Fax:727-772-0400
Practice Address - Street 1:2206 CURLEW RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-6823
Practice Address - Country:US
Practice Address - Phone:727-772-7788
Practice Address - Fax:727-772-0400
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70157OtherBLUE CROSS BLUE SHIELD
FL381863200Medicaid
FL619732OtherUNITED HEALTH CARE
FL70157OtherBLUE CROSS BLUE SHIELD
FL381863200Medicaid