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General NPI Number Information
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NPI Number | 1225080872
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Entity Type | Organization
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Legal Business Name | JASON P. GODO, DC, SC
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 3118 N SHEFFIELD AVE UNIT 1S
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City | CHICAGO
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State | IL
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Zip | 60657-8680
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Country | US
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Telephone | 773-525-0007
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Fax | 773-525-0050
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Provider Business Mailing Address
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Address Line | 3118 N SHEFFIELD AVE UNIT 1S
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City | CHICAGO
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State | IL
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Zip | 60657-8680
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Country | US
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Telephone | 773-525-0007
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Fax | 773-525-0050
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. JASON P GODO
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Credential | DC
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Telephone | 773-525-0007
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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 | 38010089
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License Number State | IL
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