Provider Demographics
NPI:1831574714
Name:GOOD, RUDJAR (DC)
Entity type:Individual
Prefix:DR
First Name:RUDJAR
Middle Name:
Last Name:GOOD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:RUDJAR
Other - Middle Name:
Other - Last Name:GHARAGOZLOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:46B WEST GUDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4358
Mailing Address - Country:US
Mailing Address - Phone:240-361-2225
Mailing Address - Fax:240-361-0719
Practice Address - Street 1:46 W GUDE DR STE B
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4358
Practice Address - Country:US
Practice Address - Phone:240-361-2225
Practice Address - Fax:240-361-0719
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor