Provider Demographics
NPI:1659588416
Name:OGAO, JON M (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:M
Last Name:OGAO
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 506
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84091-0506
Mailing Address - Country:US
Mailing Address - Phone:801-495-9330
Mailing Address - Fax:801-302-5829
Practice Address - Street 1:10393 S 1300 W
Practice Address - Street 2:STE. 102
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8883
Practice Address - Country:US
Practice Address - Phone:801-495-9330
Practice Address - Fax:801-302-5829
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT335161-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor