Provider Demographics
NPI:1861883258
Name:GOODMAN, RYAN PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:PAUL
Last Name:GOODMAN
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 1:303 WOOD IBIS AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-7539
Mailing Address - Country:US
Mailing Address - Phone:248-762-3312
Mailing Address - Fax:
Practice Address - Street 1:34602 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2147
Practice Address - Country:US
Practice Address - Phone:727-722-7700
Practice Address - Fax:727-722-7711
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor