| Organization Name: | GOFORTH HEALTH CENTER, LLC |
| NPI Number: | 1114347705 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LARRY MARK GOFORTH (CHIROPRACTIC PHYSICIAN) |
| Mailing Address: | 4344 Osage Beach Pkwy A2 Osage Beach |
| State: | MO US |
| Postal Code: | 650652175 |
| Phone Number: | 5733489800 |
| Fax Number: | |
| NPI Enumeration Date: | 04/22/2014 |
| NPI Last Update Date: | 04/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | CE0006497 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |