Organization
GOODELL CHIROPRACTIC OFFICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY GOODELL DC (OWNER)
(262) 886-8600
Entity
Organization
Contact information
Practice address
8020 DURAND AVE, STURTEVANT, WI 53177-1976
(262) 886-8600
(262) 886-5342
Mailing address
8020 DURAND AVE, PO BOX 392, STURTEVANT, WI 53177-1976
(262) 886-8600
(262) 886-5342
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
224512
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
350024280
MEDICARE RAILROAD
WI
05
—
38886700
—
WI
Enumeration date
11/11/2013
Last updated
11/11/2013
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