Healthcare Provider Details

I. General information

NPI: 1528166519
Provider Name (Legal Business Name): JONATHAN BRADY GOSE D.C. DACBSP DACRB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S PLAINS RD
THE PLAINS OH
45780-1332
US

IV. Provider business mailing address

22 S PLAINS RD
THE PLAINS OH
45780-1332
US

V. Phone/Fax

Practice location:
  • Phone: 740-797-4949
  • Fax: 740-797-1889
Mailing address:
  • Phone: 740-797-4949
  • Fax: 740-797-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2930
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: