Provider Demographics
NPI:1003012246
Name:JONES, RYAN MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MATTHEW
Last Name:JONES
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:PO BOX 2676
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-0676
Mailing Address - Country:US
Mailing Address - Phone:209-383-6473
Mailing Address - Fax:209-383-6474
Practice Address - Street 1:460 W 25TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2822
Practice Address - Country:US
Practice Address - Phone:209-383-6473
Practice Address - Fax:209-383-6474
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0298950Medicare ID - Type Unspecified