Provider Demographics
NPI:1447279450
Name:GOODWIN, SUSAN V (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:V
Last Name:GOODWIN
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 1:1800 OAK PARK BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4479
Mailing Address - Country:US
Mailing Address - Phone:925-287-0130
Mailing Address - Fax:925-287-4637
Practice Address - Street 1:1800 OAK PARK BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4479
Practice Address - Country:US
Practice Address - Phone:925-287-0130
Practice Address - Fax:925-287-4637
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADL884ZMedicare PIN