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General NPI Number Information
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NPI Number | 1114688090
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Entity Type | Individual
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Provider Name | JONATHAN SO DC
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Gender | Male
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 721 N BEERS ST STE 1E
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City | HOLMDEL
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State | NJ
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Zip | 07733-1500
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Country | US
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Telephone | 732-858-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 5 TUDOR CITY PL APT 1825
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City | NEW YORK
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State | NY
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Zip | 10017-6877
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Country | US
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Telephone | 732-858-4000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00790900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 013552
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License Number State | NY
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