Individual
DR. KENNETH ALAN GOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
3040 N FIVE MILE RD, SUITE C, BOISE, ID 83713-5234
(208) 324-8484
(208) 321-5084
Mailing address
3040 N FIVE MILE RD, SUITE C, BOISE, ID 83713-5234
(208) 324-8484
(208) 321-5084
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
3994
OR
111N00000X
Chiropractor
Primary
CHIA-1501
ID
Other
Enumeration date
02/11/2010
Last updated
04/25/2012
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