Healthcare Provider Details

I. General information

NPI: 1689730202
Provider Name (Legal Business Name): NELSON T GOFF D.C., CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74282 HIGHWAY 111
PALM DESERT CA
92260-4139
US

IV. Provider business mailing address

PO BOX 7
PALM DESERT CA
92261-0007
US

V. Phone/Fax

Practice location:
  • Phone: 760-365-0881
  • Fax: 760-365-7681
Mailing address:
  • Phone: 760-365-0881
  • Fax: 760-365-7681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1174
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC18097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: