Provider Demographics
NPI:1619920915
Name:ANDERSON, JONATHON MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:MICHAEL
Last Name:ANDERSON
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 1345
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:KS
Mailing Address - Zip Code:67878-1345
Mailing Address - Country:US
Mailing Address - Phone:620-384-5338
Mailing Address - Fax:
Practice Address - Street 1:207 N. MAIN
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:KS
Practice Address - Zip Code:67878
Practice Address - Country:US
Practice Address - Phone:620-384-5338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5623111N00000X
KS01-05027111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor