Scott Theodor Godbersen, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2008015775 Issued in MO

Practice address

1400 Waldo Halter Mem Dr
Neosho, MO 64850-2034

Phone

(417) 455-1025

Fax

(417) 455-2273

NPI assigned

Aug 15, 2006

Last updated

Apr 6, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• 1St Choice Chiropractic Center PC

  • Chiropractor
  • Neosho, MO
  • NPI 1477742732
  Medicare reassignment NPD Authorized official
• Carlson Chiropractic Center PC

  • Chiropractor
  • Joplin, MO
  • NPI 1760546584
  NPD (past)
• Frack Chiropractic & Wellness Center PC

  • Chiropractor
  • Webb City, MO
  • NPI 1649355140
  NPD (past)
• Archetype Chiropractic Center

  • Chiropractor
  • Waite Park, MN
  • NPI 1144498593
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428278400000",
    "number": "1215940440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 WALDO HALTER MEM DR",
            "address_2": "PO BOX 355",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648502034",
            "telephone_number": "417-455-1025",
            "fax_number": "417-455-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 WALDO HALTER MEM DR",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648502034",
            "telephone_number": "417-455-1025",
            "fax_number": "417-455-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODBERSEN",
        "first_name": "SCOTT",
        "middle_name": "THEODOR",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2015-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4833",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OK",
            "license": "3847",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2008015775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dadrion Annette Gaston, R.PH
• Natasha Gates, RN
• Gateway Emergency Physicians, LLP
• Danette J Gault
• Jenny Kay Gilbert, BCABA
• Jeffrey Tyler Gossett, DDS
• Majel Gramm
• Colton Green, PTA
• Kristin Dyan Green, D.D.S.
• Julie Gummelt

• Chiropractor in Neosho, MO
• Providers in Neosho, MO by specialty
• Chiropractor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.