Provider Demographics
NPI:1811208283
Name:PAVLICK, JONATHAN WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:WILLIAM
Last Name:PAVLICK
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 1:114 PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-3013
Mailing Address - Country:US
Mailing Address - Phone:717-343-6983
Mailing Address - Fax:
Practice Address - Street 1:114 PRINCE ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-3013
Practice Address - Country:US
Practice Address - Phone:717-343-6983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor