Provider Demographics
NPI:1215350624
Name:WARNINGER, JONATHON JACOB (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:JACOB
Last Name:WARNINGER
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 1:716 HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-2858
Mailing Address - Country:US
Mailing Address - Phone:570-664-7573
Mailing Address - Fax:570-664-8128
Practice Address - Street 1:395 MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-2630
Practice Address - Country:US
Practice Address - Phone:570-207-1263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011090111N00000X
PAMSG008660174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030675430001Medicaid