Provider Demographics
NPI:1386719102
Name:GODWIN, MATTHEW W (DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:GODWIN
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 1:33125 SAINT JOE RD
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-0300
Mailing Address - Country:US
Mailing Address - Phone:813-810-2689
Mailing Address - Fax:
Practice Address - Street 1:5346 8TH ST
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-4336
Practice Address - Country:US
Practice Address - Phone:813-782-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382279600Medicaid
FL382279600Medicaid