Provider Demographics
NPI:1194790543
Name:OAKLEY, JOHNATHAN W (DC)
Entity type:Individual
Prefix:DR
First Name:JOHNATHAN
Middle Name:W
Last Name:OAKLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:212 THOMPSON POYNTER RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-7238
Mailing Address - Country:US
Mailing Address - Phone:606-864-1444
Mailing Address - Fax:606-864-1269
Practice Address - Street 1:130 THOMPSON POYNTER RD
Practice Address - Street 2:SUITE 4
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-7238
Practice Address - Country:US
Practice Address - Phone:606-864-1444
Practice Address - Fax:606-864-1269
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85003929Medicaid
KY85003929Medicaid