MEDICARE: JOHNATHON DEAN CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1790498061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNATHON DEAN CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	3543 W MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-7015
Country	:	US
Telephone Number	:	405-440-3326
Fax Number	:

Provider Business Practice Location Address
First Line	:	3543 W MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-7015
Country	:	US
Telephone Number	:	405-440-3326
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. JOHNATHON DEAN
Credential	:	DC
Telephone Number	:	405-440-3326

Provider Enumeration Date	:	01/03/2023
Last Update Date	:	01/03/2023

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