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General NPI Number Information
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NPI Number | 1275991341
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Entity Type | Individual
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Provider Name | JASON GO
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Gender | Male
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 1201 STONE ST SUITE 3
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City | PORT HURON
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State | MI
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Zip | 48060-3563
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Country | US
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Telephone | 312-622-3659
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Fax |
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Provider Business Mailing Address
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Address Line | 863 RIVERVIEW LN
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City | MARYSVILLE
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State | MI
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Zip | 48040-1507
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Country | US
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Telephone | 312-622-3659
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 54010000157
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License Number State | MI
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