Provider Demographics
NPI:1427083575
Name:GOODGE, JAMES LLOYD III (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LLOYD
Last Name:GOODGE
Suffix:III
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 1:1100 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-3614
Mailing Address - Country:US
Mailing Address - Phone:412-279-4040
Mailing Address - Fax:412-279-4041
Practice Address - Street 1:1100 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-3614
Practice Address - Country:US
Practice Address - Phone:412-279-4040
Practice Address - Fax:412-279-4041
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 002058L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA143958OtherBLUE CROSS
PA143958F22Medicaid
PA143958OtherBLUE CROSS
PA143958F22Medicare ID - Type Unspecified