Provider Demographics
NPI:1841583929
Name:JAHNA, MARCUS ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:ANTHONY
Last Name:JAHNA
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 1:23857 HWY 27
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33859-7811
Mailing Address - Country:US
Mailing Address - Phone:863-949-4815
Mailing Address - Fax:863-949-4826
Practice Address - Street 1:23857 HWY 27
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33859-0000
Practice Address - Country:US
Practice Address - Phone:863-949-4815
Practice Address - Fax:863-949-4826
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor