Provider Demographics
NPI:1689730202
Name:GOFF, NELSON T (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:T
Last Name:GOFF
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57374 29 PALMS HWY
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2927
Mailing Address - Country:US
Mailing Address - Phone:760-365-0881
Mailing Address - Fax:760-365-7681
Practice Address - Street 1:57374 29 PALMS HWY
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2927
Practice Address - Country:US
Practice Address - Phone:760-365-0881
Practice Address - Fax:760-365-7681
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1174111NS0005X, 111NS0005X
CADC18097111N00000X
AZ4224111N00000X
CA96111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18097OtherSTATE BOARD OF CHIROPRACTIC EXAMINERS
CADC0180970Medicare ID - Type UnspecifiedMEDICARE NUMBER