Provider Demographics
NPI:1730276528
Name:GOAT, DAVID ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:GOAT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:ALAN
Other - Last Name:GOAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12216 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5914
Mailing Address - Country:US
Mailing Address - Phone:405-692-8400
Mailing Address - Fax:405-692-8401
Practice Address - Street 1:12216 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-5914
Practice Address - Country:US
Practice Address - Phone:405-692-8400
Practice Address - Fax:405-692-8401
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3147111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5314Medicare UPIN