Healthcare Provider Details

I. General information

NPI: 1124731799
Provider Name (Legal Business Name): JONNA DAYNE ISAAC DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 STAR SHOOT PKWY STE 190
LEXINGTON KY
40509-4569
US

IV. Provider business mailing address

1890 STAR SHOOT PKWY STE 190
LEXINGTON KY
40509-4569
US

V. Phone/Fax

Practice location:
  • Phone: 859-263-2774
  • Fax: 859-263-2787
Mailing address:
  • Phone: 859-263-2774
  • Fax: 859-263-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number282073
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: