Healthcare Provider Details

I. General information

NPI: 1760480925
Provider Name (Legal Business Name): JONATHAN NORMAN GROUP D.C., R.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ROUTE 134 SUITE 103
SOUTH DENNIS MA
02660-3739
US

IV. Provider business mailing address

24 ROUTE 134 SUITE 103
SOUTH DENNIS MA
02660-3739
US

V. Phone/Fax

Practice location:
  • Phone: 508-394-4847
  • Fax: 508-394-3638
Mailing address:
  • Phone: 508-394-4847
  • Fax: 508-394-3638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number807851
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3028
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: