Provider Demographics
NPI:1003959529
Name:JONES, JAMES LESLIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LESLIE
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 1:175 STARK ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:WI
Mailing Address - Zip Code:53956-1243
Mailing Address - Country:US
Mailing Address - Phone:920-326-6336
Mailing Address - Fax:920-326-6444
Practice Address - Street 1:175 STARK ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:WI
Practice Address - Zip Code:53956-1243
Practice Address - Country:US
Practice Address - Phone:920-326-6336
Practice Address - Fax:920-326-6444
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3182-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU55831Medicare UPIN
WI000070816Medicare ID - Type Unspecified