Provider Demographics
NPI:1316017452
Name:JONES, MARK KEVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:KEVIN
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 1:3848 CAMPUS DR STE 104
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2664
Mailing Address - Country:US
Mailing Address - Phone:949-246-2200
Mailing Address - Fax:949-724-0185
Practice Address - Street 1:3848 CAMPUS DR STE 104
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2664
Practice Address - Country:US
Practice Address - Phone:949-246-2200
Practice Address - Fax:949-724-0185
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23536Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION