Provider Demographics
NPI:1366618969
Name:GOSS, JASON KENNETH (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:KENNETH
Last Name:GOSS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23043 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2719
Mailing Address - Country:US
Mailing Address - Phone:661-288-0022
Mailing Address - Fax:661-288-2030
Practice Address - Street 1:23043 LYONS AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2719
Practice Address - Country:US
Practice Address - Phone:661-288-0022
Practice Address - Fax:661-288-2030
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor