Provider Demographics
NPI:1558417477
Name:GOUGE, FRANKLIN W (DC)
Entity Type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:W
Last Name:GOUGE
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 1:208 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-2206
Mailing Address - Country:US
Mailing Address - Phone:541-298-2904
Mailing Address - Fax:541-296-8235
Practice Address - Street 1:208 E 4TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2206
Practice Address - Country:US
Practice Address - Phone:541-298-2904
Practice Address - Fax:541-296-8235
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR106166Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER