Provider Demographics
NPI:1194748939
Name:LINDSEY, JONATHAN JAY (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JAY
Last Name:LINDSEY
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 1:211 N WHITLEY DR
Mailing Address - Street 2:STE. 4
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-2704
Mailing Address - Country:US
Mailing Address - Phone:208-452-7582
Mailing Address - Fax:
Practice Address - Street 1:211 N WHITLEY DR
Practice Address - Street 2:STE. 4
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2704
Practice Address - Country:US
Practice Address - Phone:208-452-7582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
C5822OtherBLUE CROSS
ID000010157423OtherBLUE SHIELD
ID807598100Medicaid
C5822OtherBLUE CROSS
ID1672835Medicare PIN
ID1672835Medicare UPIN