Provider Demographics
NPI:1437573458
Name:NOWLAND, JONATHAN (DC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:NOWLAND
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 1:2031 E HOSPITALITY LN
Mailing Address - Street 2:STE 150
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-6603
Mailing Address - Country:US
Mailing Address - Phone:916-780-1370
Mailing Address - Fax:916-780-1413
Practice Address - Street 1:720 SUNRISE AVE STE 104B
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4508
Practice Address - Country:US
Practice Address - Phone:916-780-1370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1671111N00000X
CADC32820111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty