Provider Demographics
NPI:1104983832
Name:EATON, JONTHAN KYLE (DC)
Entity type:Individual
Prefix:
First Name:JONTHAN
Middle Name:KYLE
Last Name:EATON
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 1:2753 HIGHWAY 195
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35503-6241
Mailing Address - Country:US
Mailing Address - Phone:205-221-2442
Mailing Address - Fax:205-221-2437
Practice Address - Street 1:2753 HIGHWAY 195
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35503-6241
Practice Address - Country:US
Practice Address - Phone:205-221-2442
Practice Address - Fax:205-221-2437
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U85693Medicare UPIN