Provider Demographics
NPI:1467615245
Name:MESSENGER, JON DARIC (DC)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:DARIC
Last Name:MESSENGER
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 1:7570 W 21ST ST N STE 1006A
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1773
Mailing Address - Country:US
Mailing Address - Phone:316-337-5757
Mailing Address - Fax:316-337-5758
Practice Address - Street 1:7570 W 21ST ST N STE 1006A
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1773
Practice Address - Country:US
Practice Address - Phone:316-337-5757
Practice Address - Fax:316-337-5758
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor