Healthcare Provider Details

I. General information

NPI: 1982836938
Provider Name (Legal Business Name): JON MICHAEL GODFREY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 6TH AVE E
ALEXANDRIA MN
56308-1801
US

IV. Provider business mailing address

119 6TH AVE E
ALEXANDRIA MN
56308-1801
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-8185
  • Fax: 320-762-8186
Mailing address:
  • Phone: 320-762-8185
  • Fax: 320-762-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5255
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: