Provider Demographics
NPI:1922721778
Name:GO FORTH ENTERPRISES LLC
Entity Type:Organization
Organization Name:GO FORTH ENTERPRISES LLC
Other - Org Name:THE STRESS RELIEF ZONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:TERRELL
Authorized Official - Last Name:GUNNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-249-5333
Mailing Address - Street 1:289 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2482
Mailing Address - Country:US
Mailing Address - Phone:801-766-4741
Mailing Address - Fax:801-766-8582
Practice Address - Street 1:289 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2482
Practice Address - Country:US
Practice Address - Phone:801-766-4741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1952356305OtherNPI