Provider Demographics
NPI:1578553244
Name:TINKLE, JONATHAN KELLY (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:KELLY
Last Name:TINKLE
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 1:212 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-3033
Mailing Address - Country:US
Mailing Address - Phone:765-935-1000
Mailing Address - Fax:765-935-1493
Practice Address - Street 1:212 N 8TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-3033
Practice Address - Country:US
Practice Address - Phone:765-935-1000
Practice Address - Fax:765-935-1493
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0800218LA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
224060Medicare ID - Type Unspecified
V03935Medicare UPIN