Healthcare Provider Details

I. General information

NPI: 1750343430
Provider Name (Legal Business Name): JONAS E MARRY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 WASHINGTON RD SUITE 101
MC MURRAY PA
15317-3189
US

IV. Provider business mailing address

3150 WASHINGTON RD SUITE 101
MC MURRAY PA
15317-3189
US

V. Phone/Fax

Practice location:
  • Phone: 724-941-9507
  • Fax: 724-941-9504
Mailing address:
  • Phone: 724-941-9507
  • Fax: 724-941-9504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC007510L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1631445
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: