Provider Demographics
NPI:1306935119
Name:GOODRICH, AIXA (DC)
Entity type:Individual
Prefix:DR
First Name:AIXA
Middle Name:
Last Name:GOODRICH
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 1:7990 SW 117TH AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3847
Mailing Address - Country:US
Mailing Address - Phone:305-271-7447
Mailing Address - Fax:305-271-7448
Practice Address - Street 1:7990 SW 117TH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3847
Practice Address - Country:US
Practice Address - Phone:305-271-7447
Practice Address - Fax:305-271-7448
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL331762791Medicaid
FLE4167XMedicare ID - Type Unspecified
FLU80450Medicare UPIN