Provider Demographics
NPI:1710024054
Name:HAIGH, JONATHAN ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ALLEN
Last Name:HAIGH
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 1:4625 SAINT REGIS DR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-3988
Mailing Address - Country:US
Mailing Address - Phone:262-554-1978
Mailing Address - Fax:
Practice Address - Street 1:3900 WASHINGTON ST STE I
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5715
Practice Address - Country:US
Practice Address - Phone:847-782-9280
Practice Address - Fax:847-782-9285
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-01029111N00000X
WI0004070-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932423OtherBLUE CROSS PROVIDER #
IL04932423OtherBLUE CROSS PROVIDER #
ILK17796Medicare ID - Type UnspecifiedMEDICARE PROVIDER #