Basic Information
| Provider Information | |||||||||
| NPI: | 1861545709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FIELDS | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20508 SHERMAN WAY | ||||||||
| Address2: | SUITE B | ||||||||
| City: | WINNETKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913063428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182519711 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20508 SHERMAN WAY | ||||||||
| Address2: | SUITE B | ||||||||
| City: | WINNETKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913063428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182519711 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | DC15791 | CA | Y | Chiropractic Providers | Chiropractor |
No ID Information.