Provider Demographics
NPI:1760480925
Name:GROUP, JONATHAN NORMAN (DC, RD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:NORMAN
Last Name:GROUP
Suffix:
Gender:M
Credentials:DC, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ROUTE 134
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SOUTH DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02660-3739
Mailing Address - Country:US
Mailing Address - Phone:508-394-4847
Mailing Address - Fax:508-394-3638
Practice Address - Street 1:24 ROUTE 134
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-3739
Practice Address - Country:US
Practice Address - Phone:508-394-4847
Practice Address - Fax:508-394-3638
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
807851133V00000X
247200000X
MA3028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F4483Medicare PIN