Provider Demographics
NPI:1972665099
Name:YAKISH, JON (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:YAKISH
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 1:9860 SUMMER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2604
Mailing Address - Country:US
Mailing Address - Phone:770-643-9759
Mailing Address - Fax:
Practice Address - Street 1:105 OLD ALABAMA ROAD CONNECTOR
Practice Address - Street 2:SUITE 9A
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022
Practice Address - Country:US
Practice Address - Phone:770-641-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU94817Medicare UPIN