=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922721778
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GO FORTH ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2022
-----------------------------------------------------
Last Update Date | 10/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 289 E MAIN ST STE A
-----------------------------------------------------
City | LEHI
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84043-2482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-766-4741
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 289 E MAIN ST STE A
-----------------------------------------------------
City | LEHI
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84043-2482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-766-4741
-----------------------------------------------------
Fax | 801-766-8582
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. JEFFREY TERRELL GUNNELL
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 208-249-5333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------