Provider Demographics
NPI:1457141178
Name:GOODMAN, CHAD JOAQUIN
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:JOAQUIN
Last Name:GOODMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3604
Mailing Address - Country:US
Mailing Address - Phone:254-315-0771
Mailing Address - Fax:
Practice Address - Street 1:1217 S HEWITT DR
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-3200
Practice Address - Country:US
Practice Address - Phone:254-315-0771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT141900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist