Provider Demographics
NPI:1043484793
Name:NORDSTROM, JONATHAN OWEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:OWEN
Last Name:NORDSTROM
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 1:800 W 18TH ST
Mailing Address - Street 2:STE. 120
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3758
Mailing Address - Country:US
Mailing Address - Phone:405-286-0322
Mailing Address - Fax:405-285-7034
Practice Address - Street 1:800 W 18TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3758
Practice Address - Country:US
Practice Address - Phone:405-286-0322
Practice Address - Fax:405-285-7034
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor