Provider Demographics
NPI:1275930232
Name:ROJJANASRIRAT, JONATHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:ROJJANASRIRAT
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 1:2626 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 107-109
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-4005
Mailing Address - Country:US
Mailing Address - Phone:702-675-4500
Mailing Address - Fax:702-675-4501
Practice Address - Street 1:2626 S RAINBOW BLVD
Practice Address - Street 2:SUITE 107-109
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-4005
Practice Address - Country:US
Practice Address - Phone:702-675-4500
Practice Address - Fax:702-675-4501
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor