Provider Demographics
NPI:1033396106
Name:JONES, PAULA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:PAULA
Other - Middle Name:MARIE
Other - Last Name:FUCCILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:14074 TRADE CENTER DR
Mailing Address - Street 2:SUITE 136
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4563
Mailing Address - Country:US
Mailing Address - Phone:317-410-4242
Mailing Address - Fax:
Practice Address - Street 1:14074 TRADE CENTER DR
Practice Address - Street 2:SUITE 136
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-4563
Practice Address - Country:US
Practice Address - Phone:317-410-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN8001827A111N00000X
NY009084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX6Z501Medicare UPIN
ININ2719002Medicare UPIN