Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 06715 | IA |
NPI | 1003870924 |
---|---|
Provider Name | Amy J Goulet |
First Address | Bettendorf, IA 52722-3251 |
Second Address | Bettendorf, IA 52722-3251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 28/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0450536 | (05) | IA |
1477566404 | GROUP NPI (01) | IA |