Provider Demographics
NPI:1013216332
Name:VITO, JONATHAN D (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:D
Last Name:VITO
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 1:5955 ZEAMER AVE
Mailing Address - Street 2:
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99506-3702
Mailing Address - Country:US
Mailing Address - Phone:907-580-0556
Mailing Address - Fax:
Practice Address - Street 1:8840 OLD SEWARD HWY STE E
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2000
Practice Address - Country:US
Practice Address - Phone:907-346-5255
Practice Address - Fax:907-346-5256
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCHIC526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty