Provider Demographics
NPI:1174672646
Name:HAUG, JONATHON MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:MICHAEL
Last Name:HAUG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1265 HIGHWAY 10 W
Mailing Address - Street 2:SUITE 9
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-2236
Mailing Address - Country:US
Mailing Address - Phone:218-847-4700
Mailing Address - Fax:218-847-4700
Practice Address - Street 1:1265 HIGHWAY 10 W
Practice Address - Street 2:SUITE 9
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-2236
Practice Address - Country:US
Practice Address - Phone:218-847-4700
Practice Address - Fax:218-847-4700
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN64272Medicare UPIN