Individual
DR. FORREST WAYNE GOFORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
108 W HILL AVE, GALLUP, NM 87301-6218
(505) 722-9002
(505) 722-7031
Mailing address
108 W HILL AVE, GALLUP, NM 87301-6218
(505) 722-9002
(505) 722-7031
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
06-00001390
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
608817900
FED WORKER'S COMP
NM
01
—
NMA101797
MEDICARE ID
NM
Enumeration date
12/01/2006
Last updated
06/08/2012
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