Provider Demographics
NPI:1891792701
Name:WASSERMANN, JONATHAN DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID
Last Name:WASSERMANN
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:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-0901
Mailing Address - Country:US
Mailing Address - Phone:215-368-4222
Mailing Address - Fax:215-368-8321
Practice Address - Street 1:601 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2947
Practice Address - Country:US
Practice Address - Phone:215-368-4222
Practice Address - Fax:215-368-8321
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA005166-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWA522212Medicare UPIN