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General NPI Number Information
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NPI Number | 1437567856
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Entity Type | Individual
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Provider Name | KYLENE GOFORTH DIPL. AC., RAC.
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Gender | Female
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 113 S SAGINAW ST
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City | HOLLY
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State | MI
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Zip | 48442-1690
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Country | US
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Telephone | 810-333-7991
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Fax |
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Provider Business Mailing Address
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Address Line | 3308 ARBOR DR
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City | FENTON
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State | MI
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Zip | 48430-3127
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Country | US
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Telephone | 810-333-7991
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 5401000125
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License Number State | MI
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