Provider Demographics
NPI:1427024645
Name:WUEST, JON MATTHEW (DC)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:MATTHEW
Last Name:WUEST
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:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071
Mailing Address - Country:US
Mailing Address - Phone:270-759-1945
Mailing Address - Fax:270-759-1517
Practice Address - Street 1:1313 JOHNSON BLVD
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071
Practice Address - Country:US
Practice Address - Phone:270-759-1945
Practice Address - Fax:270-759-1517
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00219154OtherPALMETTO RAILROADMEDICARE
KY000000366441OtherANTHEM
KY000000366441OtherANTHEM
KYP00219154OtherPALMETTO RAILROADMEDICARE