Provider Demographics
NPI:1881625192
Name:GOODGE, JAMES LLOYD IV (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LLOYD
Last Name:GOODGE
Suffix:IV
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 1:105 W OHARA ST
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:PA
Mailing Address - Zip Code:15057-1441
Mailing Address - Country:US
Mailing Address - Phone:724-926-2131
Mailing Address - Fax:
Practice Address - Street 1:105 W OHARA ST
Practice Address - Street 2:
Practice Address - City:MC DONALD
Practice Address - State:PA
Practice Address - Zip Code:15057-1441
Practice Address - Country:US
Practice Address - Phone:724-926-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1666783OtherBLUE CROSS
PA08930F22Medicaid
PAV04988Medicare UPIN
PA08930F22Medicare ID - Type Unspecified