Provider Demographics
NPI:1487784070
Name:GOFF, W DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:W
Middle Name:DAVID
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 1:638 W DUARTE RD STE 16
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7672
Mailing Address - Country:US
Mailing Address - Phone:626-445-3242
Mailing Address - Fax:626-445-0258
Practice Address - Street 1:638 W DUARTE RD STE 16
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7672
Practice Address - Country:US
Practice Address - Phone:626-445-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2010-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01599ZMedicare UPIN
CAU64123Medicare UPIN