Provider Demographics
NPI:1265789655
Name:GOINS, JONATHAN RUBEN (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RUBEN
Last Name:GOINS
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:P.O BOX 10002
Mailing Address - Street 2:PMB 244
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-989-4561
Mailing Address - Fax:
Practice Address - Street 1:394 NAURU LOOP ST.
Practice Address - Street 2:SUITE 204
Practice Address - City:SUSUPE
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-989-4561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor