Provider Demographics
NPI:1235385543
Name:GOTT CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:GOTT CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-794-4774
Mailing Address - Street 1:1012 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-4557
Mailing Address - Country:US
Mailing Address - Phone:208-794-4774
Mailing Address - Fax:
Practice Address - Street 1:1012 10TH AVE S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4557
Practice Address - Country:US
Practice Address - Phone:208-794-4774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA490261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807954500Medicaid
ID16718901Medicare PIN