Provider Demographics
NPI:1144209933
Name:JONES, JERALD L (DC)
Entity Type:Individual
Prefix:DR
First Name:JERALD
Middle Name:L
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 1:301 ANDREWS AVE.
Mailing Address - Street 2:LYSTER ARMY HEALTH CLINIC
Mailing Address - City:FT. RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362
Mailing Address - Country:US
Mailing Address - Phone:334-225-7706
Mailing Address - Fax:
Practice Address - Street 1:301 ANDREWS AVE.
Practice Address - Street 2:LYSTER ARMY HEALTH CLINIC, CHIROPRACTIC CLINIC
Practice Address - City:FT. RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362
Practice Address - Country:US
Practice Address - Phone:334-225-7706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2120111N00000X
OH2730111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U72749Medicare UPIN
OH0862131Medicare ID - Type Unspecified
2079978Medicare ID - Type Unspecified