Provider Demographics
NPI:1194926907
Name:OWENS, JONATHAN COOPER (DC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:COOPER
Last Name:OWENS
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 1:1904 PROVIDENCE ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3717
Mailing Address - Country:US
Mailing Address - Phone:636-332-2569
Mailing Address - Fax:
Practice Address - Street 1:104 MULLACH CT
Practice Address - Street 2:SUITE 1000
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-4852
Practice Address - Country:US
Practice Address - Phone:636-327-0700
Practice Address - Fax:636-332-9103
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006028213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor