Provider Demographics
NPI:1891750311
Name:LEVINE, JONATHAN JAMES (DC, THERAPY PROVIDER)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JAMES
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DC, THERAPY PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 S PRICE RD
Mailing Address - Street 2:SUITE D-110
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7530
Mailing Address - Country:US
Mailing Address - Phone:480-345-2080
Mailing Address - Fax:480-345-2199
Practice Address - Street 1:3330 S PRICE RD
Practice Address - Street 2:SUITE D-110
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7530
Practice Address - Country:US
Practice Address - Phone:480-345-2080
Practice Address - Fax:480-345-2199
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDC4997111N00000X
AZ2761225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2761OtherTHERAPY LICENSE NUMBER
AZDC4997OtherCHIROPRACTIC LICENSE #
AZ860828044Medicare UPIN
AZ26496Medicare ID - Type UnspecifiedMEDICARE ID NUMBER