Provider Demographics
NPI:1508299116
Name:VESTAL, JONATHAN RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RAY
Last Name:VESTAL
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 1:1809 COMMONS CIR
Mailing Address - Street 2:STE A
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-9528
Mailing Address - Country:US
Mailing Address - Phone:405-577-6268
Mailing Address - Fax:405-451-2152
Practice Address - Street 1:1809 COMMONS CIR STE A
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-9528
Practice Address - Country:US
Practice Address - Phone:405-577-6268
Practice Address - Fax:405-577-6371
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2020-11-05
Deactivation Date:2018-05-22
Deactivation Code:
Reactivation Date:2018-06-14
Provider Licenses
StateLicense IDTaxonomies
GACHIR009298111N00000X
OK4136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor