Individual
DR. SHANE ALAN GOFOURTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
88124 TERRITORIAL RD., VENETA, OR 97487
(541) 935-2242
(541) 935-2242
Mailing address
PO BOX 1108, VENETA, OR 97487-1108
(541) 935-2242
(541) 935-2242
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
27 3292
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
228849
OMAP
OR
Enumeration date
07/11/2006
Last updated
06/14/2019
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