Provider Demographics
NPI:1679800478
Name:GOODMAN, ELIZABETH ANN (DC)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:HINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1529 W. ROGERS BLVD.
Mailing Address - Street 2:STE C
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-1086
Mailing Address - Country:US
Mailing Address - Phone:918-341-6535
Mailing Address - Fax:918-341-6566
Practice Address - Street 1:1529 W ROGERS BLVD STE C
Practice Address - Street 2:STE C
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-1086
Practice Address - Country:US
Practice Address - Phone:918-396-4433
Practice Address - Fax:918-396-0075
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9833111N00000X
OK4086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK313002ZPZPOtherINDIVIDUAL PTAN
OK421306OtherGROUP PTAN