Individual
DR. THOMAS G GODBOUT III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C., CCSP
Contact information
Practice address
1352 PATRIOT BLVD, GLENVIEW, IL 60026-7777
(847) 657-0400
Mailing address
1352 PATRIOT BLVD, GLENVIEW, IL 60026-7777
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
038010264
IL
111NS0005X
Sports Physician Chiropractor
Primary
038010264
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K51546
MEDICARE PTAN
IL
Enumeration date
02/28/2007
Last updated
08/26/2016
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