Provider Demographics
NPI:1386011955
Name:DAY, JONATHAN (LAC, EAMP)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:DAY
Suffix:
Gender:M
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BAXTER AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1103
Mailing Address - Country:US
Mailing Address - Phone:502-632-4061
Mailing Address - Fax:
Practice Address - Street 1:501 BAXTER AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1103
Practice Address - Country:US
Practice Address - Phone:502-632-4061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-30
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60530821171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist