Provider Demographics
NPI:1720140049
Name:RAMIREZ, JONATHAN FERNANDO (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:FERNANDO
Last Name:RAMIREZ
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 1:111 E GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6373
Mailing Address - Country:US
Mailing Address - Phone:907-376-3064
Mailing Address - Fax:
Practice Address - Street 1:833 W COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6937
Practice Address - Country:US
Practice Address - Phone:907-376-2475
Practice Address - Fax:907-373-5154
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor