Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 0104000150 | VA |
NPI | 1629178280 |
---|---|
Provider Name | Dr. Raymond Peter Goodfield |
First Address | Culpeper, VA 22701-2825 |
Second Address | Culpeper, VA 22701-2825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T21641 | (02) | VA |