Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1021 | MS |
NPI | 1003429176 |
---|---|
Provider Name | Erik Goodwin |
First Address | Pontotoc, MS 38863 |
Second Address | Pontotoc, MS 38863 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2020 |
Last Update Date | 28/08/2020 |