Provider Demographics
NPI:1164220562
Name:CHASTEEN, JONATHAN JIM
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JIM
Last Name:CHASTEEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S DEWEY AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-3525
Mailing Address - Country:US
Mailing Address - Phone:918-336-0810
Mailing Address - Fax:918-336-0836
Practice Address - Street 1:401 S DEWEY AVE STE 108
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-3525
Practice Address - Country:US
Practice Address - Phone:918-336-0810
Practice Address - Fax:918-336-0836
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor