1649483264 NPI number — GOFFE CHIROPRACTIC CENTER, INC.

Table of content: (NPI 1649483264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649483264 NPI number — GOFFE CHIROPRACTIC CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOFFE CHIROPRACTIC CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VITAL HEALTH WELLNESS CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649483264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 REGENCY RIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45459-4251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-435-1895
Provider Business Mailing Address Fax Number:
937-435-1884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 REGENCY RIDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45459-4251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-435-1895
Provider Business Practice Location Address Fax Number:
937-435-1884
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOFFE
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
937-435-1895

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1792 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0807661 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0968458 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000020645 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 44-20167 . This is a "UHC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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