Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 16284 | AR |
NPI | 1003499054 |
---|---|
Provider Name | Dr. Garrett Martin Goodlett |
First Address | Little Rock, AR 72223-2065 |
Second Address | Little Rock, AR 72210-2370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2021 |
Last Update Date | 28/04/2021 |