Provider Demographics
NPI:1811135635
Name:GEOFFROI A. GOLAY, D.C., PLLC
Entity type:Organization
Organization Name:GEOFFROI A. GOLAY, D.C., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFROI
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-733-0123
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:83301-4800
Mailing Address - Country:US
Mailing Address - Phone:208-733-0123
Mailing Address - Fax:
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:83301-4800
Practice Address - Country:US
Practice Address - Phone:208-733-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U65608Medicare UPIN
1673529Medicare PIN