Provider Demographics
NPI:1053735118
Name:PHARES, JONAS LAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:JONAS
Middle Name:LAYNE
Last Name:PHARES
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 1:9302 CHATEAU DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-7468
Mailing Address - Country:US
Mailing Address - Phone:304-481-5714
Mailing Address - Fax:
Practice Address - Street 1:RT 20 PROFESSIONAL ARTS PLAZA DR
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201
Practice Address - Country:US
Practice Address - Phone:304-472-6393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor