Provider Demographics
NPI:1649261736
Name:BUSKOHL, JODI BETH (DC)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:BETH
Last Name:BUSKOHL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62233-0366
Mailing Address - Country:US
Mailing Address - Phone:618-826-5475
Mailing Address - Fax:
Practice Address - Street 1:2447 STATE ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:IL
Practice Address - Zip Code:62233-1147
Practice Address - Country:US
Practice Address - Phone:618-826-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-29
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL393631OtherHEALTHLINK
IL07922707OtherBLUE CROSS/BLUE SHIELD
IL31419OtherCMR
ILK41078Medicare PIN