Provider Demographics
NPI:1548354061
Name:GOODWIN, JOHN MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2682 BABBLE CREEK LANE
Mailing Address - Street 2:
Mailing Address - City:O'FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368
Mailing Address - Country:US
Mailing Address - Phone:636-978-3000
Mailing Address - Fax:636-978-1821
Practice Address - Street 1:2682 BABBLE CREEK LANE
Practice Address - Street 2:
Practice Address - City:O'FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368
Practice Address - Country:US
Practice Address - Phone:636-978-3000
Practice Address - Fax:636-978-1821
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor