Provider Demographics
NPI:1205888609
Name:WASSERMANN, JONAH A (DC)
Entity type:Individual
Prefix:DR
First Name:JONAH
Middle Name:A
Last Name:WASSERMANN
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 1:4343 S STATE ROAD 7
Mailing Address - Street 2:SUITE # 108
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4009
Mailing Address - Country:US
Mailing Address - Phone:954-581-3958
Mailing Address - Fax:954-581-1430
Practice Address - Street 1:4343 S STATE ROAD 7
Practice Address - Street 2:SUITE # 108
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4009
Practice Address - Country:US
Practice Address - Phone:954-581-3958
Practice Address - Fax:954-581-1430
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53861ZMedicare ID - Type Unspecified
FLU80730Medicare UPIN