Provider Demographics
NPI:1992361281
Name:GOFF, GRADY (DC)
Entity Type:Individual
Prefix:DR
First Name:GRADY
Middle Name:
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 1:8641 W 13TH ST N STE 107
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-6280
Mailing Address - Country:US
Mailing Address - Phone:316-444-0168
Mailing Address - Fax:
Practice Address - Street 1:8641 W 13TH ST N STE 107
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-6280
Practice Address - Country:US
Practice Address - Phone:316-444-0168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor