Provider Demographics
NPI:1588872311
Name:GOODMAN, JAN (DC)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:
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 1:1911 S FEDERAL HWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3331
Mailing Address - Country:US
Mailing Address - Phone:561-455-2195
Mailing Address - Fax:561-455-2207
Practice Address - Street 1:1911 S FEDERAL HWY
Practice Address - Street 2:SUITE 400
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3331
Practice Address - Country:US
Practice Address - Phone:561-455-2195
Practice Address - Fax:561-455-2207
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBH705Medicare PIN
FLBH705AMedicare UPIN