Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 4231 | TX |
NPI | 1104923788 |
---|---|
Provider Name | Dr. Todd C. Goodale |
First Address | Houston, TX 77062-3601 |
Second Address | Houston, TX 77062-3601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
601584 | BCBS (01) | TX |
T13505 | (02) | TX |