Provider Demographics
NPI:1205469012
Name:GOODRIDGE, JUSTIN ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ROBERT
Last Name:GOODRIDGE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1364 INTERSTATE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-6187
Mailing Address - Country:US
Mailing Address - Phone:931-456-8880
Mailing Address - Fax:931-456-8883
Practice Address - Street 1:19790 ALBERTA ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-3307
Practice Address - Country:US
Practice Address - Phone:423-569-8931
Practice Address - Fax:423-569-8932
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor