Provider Demographics
NPI:1710507041
Name:GOFF, RUSSELL GREGEOR (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:GREGEOR
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 1:635 COURT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5512
Mailing Address - Country:US
Mailing Address - Phone:307-840-1734
Mailing Address - Fax:
Practice Address - Street 1:635 COURT ST STE 200
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5512
Practice Address - Country:US
Practice Address - Phone:307-840-1734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13123111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor