Provider Demographics
NPI:1346998242
Name:JONAS CHIROPRACTIC SPORTS INJURY CARE
Entity Type:Organization
Organization Name:JONAS CHIROPRACTIC SPORTS INJURY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGORTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-921-1295
Mailing Address - Street 1:99 COLD SPRING RD STE 102A
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3140
Mailing Address - Country:US
Mailing Address - Phone:516-921-1295
Mailing Address - Fax:516-496-2860
Practice Address - Street 1:99 COLD SPRING RD STE 102A
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3140
Practice Address - Country:US
Practice Address - Phone:516-921-1295
Practice Address - Fax:516-496-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY47682318OtherTAX ID