Provider Demographics
NPI:1912922105
Name:NORDQUIST, JONATHAN J (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:J
Last Name:NORDQUIST
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 1:9909 168TH ST E
Mailing Address - Street 2:102
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2513
Mailing Address - Country:US
Mailing Address - Phone:253-445-3000
Mailing Address - Fax:253-445-0301
Practice Address - Street 1:9909 168TH ST E
Practice Address - Street 2:102
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373
Practice Address - Country:US
Practice Address - Phone:253-445-3000
Practice Address - Fax:253-445-0301
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034318111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU94471Medicare UPIN
WAG8866976Medicare UPIN