Provider Demographics
NPI:1225080872
Name:JASON P. GODO, DC, SC
Entity Type:Organization
Organization Name:JASON P. GODO, DC, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:P
Authorized Official - Last Name:GODO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-525-0007
Mailing Address - Street 1:3118 N SHEFFIELD AVE
Mailing Address - Street 2:UNIT 1S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-8680
Mailing Address - Country:US
Mailing Address - Phone:773-525-0007
Mailing Address - Fax:773-525-0050
Practice Address - Street 1:3118 N SHEFFIELD AVE
Practice Address - Street 2:UNIT 1S
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-8680
Practice Address - Country:US
Practice Address - Phone:773-525-0007
Practice Address - Fax:773-525-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209164Medicare PIN