Provider Demographics
NPI:1770522336
Name:LO, JONATHAN ROMEO (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ROMEO
Last Name:LO
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 1:520 HARTBROOK DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-1402
Mailing Address - Country:US
Mailing Address - Phone:262-369-7900
Mailing Address - Fax:
Practice Address - Street 1:520 HARTBROOK DR
Practice Address - Street 2:SUITE H
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-1402
Practice Address - Country:US
Practice Address - Phone:262-369-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3876-0012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000135863Medicare PIN