Provider Demographics
NPI:1528166519
Name:GOSE, JONATHAN BRADY (DC DACBSP DACRB)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BRADY
Last Name:GOSE
Suffix:
Gender:M
Credentials:DC DACBSP DACRB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:THE PLAINS
Mailing Address - State:OH
Mailing Address - Zip Code:45780-1332
Mailing Address - Country:US
Mailing Address - Phone:740-797-4949
Mailing Address - Fax:740-797-1889
Practice Address - Street 1:22 S PLAINS RD
Practice Address - Street 2:
Practice Address - City:THE PLAINS
Practice Address - State:OH
Practice Address - Zip Code:45780-1332
Practice Address - Country:US
Practice Address - Phone:740-797-4949
Practice Address - Fax:740-797-1889
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2930111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4020401OtherMEDICARE ID PIN
OH2186156Medicaid