Provider Demographics
NPI:1841354495
Name:GOLAY, GEOFFROI ANDRE (DC)
Entity type:Individual
Prefix:DR
First Name:GEOFFROI
Middle Name:ANDRE
Last Name:GOLAY
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 1:488 BLUE LAKES BLVD N
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5236
Mailing Address - Country:US
Mailing Address - Phone:208-733-0123
Mailing Address - Fax:208-734-2610
Practice Address - Street 1:488 BLUE LAKES BLVD N
Practice Address - Street 2:SUITE 107
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5236
Practice Address - Country:US
Practice Address - Phone:208-733-0123
Practice Address - Fax:208-734-2610
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDU65608Medicare UPIN
ID1673529Medicare ID - Type Unspecified