Provider Demographics
NPI:1235142514
Name:JONES, KEVIN THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:THOMAS
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 1:309 NORTH D STREET
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3664
Mailing Address - Country:US
Mailing Address - Phone:559-781-3374
Mailing Address - Fax:559-781-6605
Practice Address - Street 1:309 NORTH D STREET
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3664
Practice Address - Country:US
Practice Address - Phone:559-781-3374
Practice Address - Fax:559-781-6605
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T06396Medicare UPIN
DC0172140Medicare ID - Type Unspecified