Individual
DR. MARK THOMAS GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
3421 KITSAP WAY, SUITE B, BREMERTON, WA 98312-2601
(360) 377-1626
(360) 377-1903
Mailing address
3421 KITSAP WAY, SUITE B, BREMERTON, WA 98312-2601
(360) 377-1626
(360) 377-1903
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH00002820
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0042155
DEPT. LABOR & INDUS. (WA)
WA
01
—
383670039
PREMERA BLUE CROSS
WA
01
—
38367003901
KITSAP PHYSICIANS SERVICE
WA
01
—
G06107
REGENCE BLUE SHIELD
WA
Enumeration date
10/31/2007
Last updated
04/16/2020
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