Provider Demographics
NPI:1225169766
Name:BREED, JON CLYDE (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:CLYDE
Last Name:BREED
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 1:134 GOLF CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-2161
Mailing Address - Country:US
Mailing Address - Phone:413-544-4274
Mailing Address - Fax:
Practice Address - Street 1:134 GOLF CLUB DR
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-2161
Practice Address - Country:US
Practice Address - Phone:413-544-4274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45536Medicare ID - Type Unspecified