MEDICARE: DR. JON MICHAEL GODFREY D.C.

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	111NR0400X	Rehabilitation Chiropractor	5255	MN

General Provider Information

NPI Number	:	1982836938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON MICHAEL GODFREY D.C.

Provider Business Mailing Address
First Line	:	119 6TH AVE E
Second Line	:
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308-1801
Country	:	US
Telephone Number	:	320-762-8185
Fax Number	:	320-762-8185

Provider Business Practice Location Address
First Line	:	119 6TH AVE E
Second Line	:
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308-1801
Country	:	US
Telephone Number	:	320-762-8185
Fax Number	:	320-762-8186

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

Provider Enumeration Date	:	08/10/2009
Last Update Date	:	08/10/2009

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