Provider Demographics
NPI:1851800593
Name:HESLOP, JONATHON MERRELL (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:MERRELL
Last Name:HESLOP
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 1:8118 KOOTENAY CT
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-6799
Mailing Address - Country:US
Mailing Address - Phone:509-346-5822
Mailing Address - Fax:509-547-1759
Practice Address - Street 1:1211 N 20TH AVE
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301
Practice Address - Country:US
Practice Address - Phone:509-547-1759
Practice Address - Fax:509-547-1759
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60789723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60789723Medicaid