Individual provider Active NPI

Matthew J Goedken, DC

  • Chiropractor
  • Madison, WI
National Provider Identifier
1336472794
Registry record updated Sep 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4540 12 Issued in WI
Practice address
1702 Eagan Rd
Madison, WI 53704-3702
Phone
(608) 243-1234
NPI assigned
Sep 16, 2009
Last updated
Sep 16, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4540 12 WI Primary

Addresses

Primary practice location

1702 Eagan Rd
Madison, WI 53704-3702

Mailing address

1702 Eagan Rd
Madison, WI 53704-3702
Phone (608) 243-1234

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4540 12WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Wilder Chiropractic, Inc. Past Accepting new patients
Chiro One Wellness Center of Madison West, LLC Chiropractor PastSince Sep 1, 2019 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253059200000",
    "number": "1336472794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 EAGAN RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537043702",
            "telephone_number": "608-243-1234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 EAGAN RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537043702",
            "telephone_number": "608-243-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOEDKEN",
        "first_name": "MATTHEW",
        "middle_name": "J",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-16",
        "last_updated": "2009-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4540 12",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.