Provider Demographics
NPI:1083616262
Name:JONES, TRENT R (DC)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:R
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 1066
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-4066
Mailing Address - Country:US
Mailing Address - Phone:765-472-7777
Mailing Address - Fax:765-472-7475
Practice Address - Street 1:20 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-2215
Practice Address - Country:US
Practice Address - Phone:765-472-7777
Practice Address - Fax:765-472-7475
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001127A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000182696OtherANTHEM
IN100179460AMedicaid
IN350013985OtherPALMETTO GBA-RR MEDICARE
INU20376Medicare UPIN
IN100179460AMedicaid