Provider Demographics
NPI:1174635049
Name:GOFF, JONATHAN ANDREW (DC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ANDREW
Last Name:GOFF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29750 US HWY 281 NORTH
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-3107
Mailing Address - Country:US
Mailing Address - Phone:830-980-3979
Mailing Address - Fax:830-438-3975
Practice Address - Street 1:29750 US HWY 281 NORTH
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-3107
Practice Address - Country:US
Practice Address - Phone:830-980-3979
Practice Address - Fax:830-438-3975
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A1598Medicare PIN