Provider Demographics
NPI:1821082108
Name:HARMON, JON MCKAY (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:MCKAY
Last Name:HARMON
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 1:9161 W BLACK EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1572
Mailing Address - Country:US
Mailing Address - Phone:208-321-1500
Mailing Address - Fax:208-321-8687
Practice Address - Street 1:9161 W BLACK EAGLE DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1572
Practice Address - Country:US
Practice Address - Phone:208-321-1500
Practice Address - Fax:208-321-8687
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC9388OtherBLUE CROSS OF IDAHO
IDCHIA590OtherLICENSE #
ID000010145823OtherBLUE SHIELD OF IDAHO
1376531Medicare ID - Type Unspecified
ID000010145823OtherBLUE SHIELD OF IDAHO