Provider Demographics
NPI:1871734137
Name:GOODMAN, CHAD E (DC)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:E
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 1:5660 N 103RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1007
Mailing Address - Country:US
Mailing Address - Phone:402-493-4333
Mailing Address - Fax:402-493-4334
Practice Address - Street 1:5660 N 103RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1007
Practice Address - Country:US
Practice Address - Phone:402-493-4333
Practice Address - Fax:402-493-4334
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8027111N00000X
NE1568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor