MEDICARE: DR. JONATHAN SO DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	38MC00790900	NJ
2	111N00000X	Chiropractor	013552	NY

General Provider Information

NPI Number	:	1114688090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN SO DC

Provider Business Mailing Address
First Line	:	721 N BEERS ST STE 1F
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1500
Country	:	US
Telephone Number	:	732-391-7548
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 N BEERS ST STE 1E
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1500
Country	:	US
Telephone Number	:	732-858-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2022
Last Update Date	:	05/15/2026

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Directions to “ DR. JONATHAN SO DC” Practice Location

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