Provider Demographics
NPI:1306371307
Name:LAYDEN, JONATHON A (DC)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:A
Last Name:LAYDEN
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 1:1206 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-2604
Mailing Address - Country:US
Mailing Address - Phone:660-582-5959
Mailing Address - Fax:660-582-6373
Practice Address - Street 1:1206 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-2604
Practice Address - Country:US
Practice Address - Phone:660-582-5959
Practice Address - Fax:660-582-6373
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016042714111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5929521837Medicare PIN