Individual
KYLENE GOFORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DIPL. AC., RAC.
Contact information
Practice address
113 S SAGINAW ST, HOLLY, MI 48442-1690
(810) 333-7991
Mailing address
3308 ARBOR DR, FENTON, MI 48430-3127
(810) 333-7991
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
5401000125
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151889
NCCAOM
—
Enumeration date
07/29/2014
Last updated
03/17/2018
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