Provider Demographics
NPI:1891932273
Name:DEAN, JONATHAN GIFFORD (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:GIFFORD
Last Name:DEAN
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 1:36800 WOODWARD AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-0917
Mailing Address - Country:US
Mailing Address - Phone:248-543-3566
Mailing Address - Fax:248-543-2628
Practice Address - Street 1:36800 WOODWARD AVE STE 210
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0917
Practice Address - Country:US
Practice Address - Phone:248-543-3566
Practice Address - Fax:248-543-2628
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009529111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P09200Medicare PIN