Provider Demographics
NPI:1881736080
Name:CHICOINE, JON K (DC)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:K
Last Name:CHICOINE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9616 N LAMAR BLVD
Mailing Address - Street 2:SUITE# 180
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-4152
Mailing Address - Country:US
Mailing Address - Phone:512-339-9888
Mailing Address - Fax:512-339-9891
Practice Address - Street 1:9616 N LAMAR BLVD
Practice Address - Street 2:SUITE# 180
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-4152
Practice Address - Country:US
Practice Address - Phone:512-339-9888
Practice Address - Fax:512-339-9891
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT01109Medicare UPIN
TX603072Medicare ID - Type Unspecified