Provider Demographics
NPI:1083913743
Name:JONES, STANLEY H
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:H
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 US HIGHWAY 50
Mailing Address - Street 2:UNIT 5
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-9226
Mailing Address - Country:US
Mailing Address - Phone:530-577-2225
Mailing Address - Fax:530-577-0812
Practice Address - Street 1:3200 US HIGHWAY 50
Practice Address - Street 2:UNIT 5
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-9226
Practice Address - Country:US
Practice Address - Phone:530-577-2225
Practice Address - Fax:530-577-0812
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11455111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor