Provider Demographics
NPI:1154494375
Name:ESTRIN, JONATHAN STEPHEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:STEPHEN
Last Name:ESTRIN
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 1:201 W KIRKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-2436
Mailing Address - Country:US
Mailing Address - Phone:641-472-0233
Mailing Address - Fax:641-209-5721
Practice Address - Street 1:201 W KIRKWOOD AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-2436
Practice Address - Country:US
Practice Address - Phone:641-472-0233
Practice Address - Fax:641-209-5721
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA24417OtherWELLMARK ID#