Provider Demographics
NPI:1871865295
Name:JAMIE GOODMAN D.C, P.A.
Entity type:Organization
Organization Name:JAMIE GOODMAN D.C, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PA
Authorized Official - Phone:727-772-7788
Mailing Address - Street 1:2323 CURLEW RD
Mailing Address - Street 2:SUITE 6C
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-9330
Mailing Address - Country:US
Mailing Address - Phone:727-772-7788
Mailing Address - Fax:
Practice Address - Street 1:2323 CURLEW RD
Practice Address - Street 2:SUITE 6C
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-9330
Practice Address - Country:US
Practice Address - Phone:727-772-7788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381863200Medicaid
FL70157OtherBLUE CROSS BLUE SHIELD
FL1507451OtherCIGNA
FL7551499OtherAETNA
FL619732OtherUNITED HEALTH CARE
FL70157OtherBLUE CROSS BLUE SHIELD
FLE6331Medicare PIN