Provider Demographics
NPI:1760261739
Name:JUKER, JON CHARLES (DC)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:CHARLES
Last Name:JUKER
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 1:614 S LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-0827
Mailing Address - Country:US
Mailing Address - Phone:208-908-9758
Mailing Address - Fax:
Practice Address - Street 1:1390 S MAPLE GROVE RD UNIT 200
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1610
Practice Address - Country:US
Practice Address - Phone:208-986-0966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-2372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor