Provider Demographics
NPI:1366672545
Name:JONES, RYAN DUANE (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DUANE
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 1:833 N 12TH W
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-5014
Mailing Address - Country:US
Mailing Address - Phone:208-351-3981
Mailing Address - Fax:
Practice Address - Street 1:833 N 12TH W
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-5014
Practice Address - Country:US
Practice Address - Phone:208-351-3981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA - 1374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor