Provider Demographics
NPI:1649344334
Name:NOU, JONATHAN C (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:C
Last Name:NOU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 MAIN ST 105
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4314
Mailing Address - Country:US
Mailing Address - Phone:301-725-6884
Mailing Address - Fax:240-524-1327
Practice Address - Street 1:525 MAIN ST 105
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4314
Practice Address - Country:US
Practice Address - Phone:301-725-6884
Practice Address - Fax:240-524-1327
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD00B232A13Medicare ID - Type Unspecified
MDU79819Medicare UPIN