Provider Demographics
NPI:1104992551
Name:JEWETT, JONATHAN A (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:A
Last Name:JEWETT
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 1:463 POOLER PKWY 218
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-5102
Mailing Address - Country:US
Mailing Address - Phone:912-691-0111
Mailing Address - Fax:
Practice Address - Street 1:1808 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-8143
Practice Address - Country:US
Practice Address - Phone:912-650-3168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV07389Medicare UPIN
GA35ZCJLFMedicare ID - Type UnspecifiedCHIROPRACTOR