Provider Demographics
NPI:1669017885
Name:GOFF, CALVIN (LAC, LMT)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:
Last Name:GOFF
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 LAURENT CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-7336
Mailing Address - Country:US
Mailing Address - Phone:614-599-9831
Mailing Address - Fax:
Practice Address - Street 1:768 PARK MEADOW RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2871
Practice Address - Country:US
Practice Address - Phone:614-392-2732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000294171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty