Healthcare Provider Details

I. General information

NPI: 1922721778
Provider Name (Legal Business Name): GO FORTH ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 E MAIN ST STE A
LEHI UT
84043-2482
US

IV. Provider business mailing address

289 E MAIN ST STE A
LEHI UT
84043-2482
US

V. Phone/Fax

Practice location:
  • Phone: 801-766-4741
  • Fax:
Mailing address:
  • Phone: 801-766-4741
  • Fax: 801-766-8582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY TERRELL GUNNELL
Title or Position: DOCTOR
Credential: DC
Phone: 208-249-5333