Provider Demographics
NPI:1063417129
Name:CHICK, JON BLAIR (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:BLAIR
Last Name:CHICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7545 BEECHMONT AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-4238
Mailing Address - Country:US
Mailing Address - Phone:513-564-4026
Mailing Address - Fax:513-564-4027
Practice Address - Street 1:7545 BEECHMONT AVE STE C
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-4238
Practice Address - Country:US
Practice Address - Phone:513-564-4026
Practice Address - Fax:513-564-4027
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.051977207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine