Provider Demographics
NPI:1417056995
Name:JONES, RICHARD GERARD (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GERARD
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 1:5770 GATEWAY BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1896
Mailing Address - Country:US
Mailing Address - Phone:513-770-3405
Mailing Address - Fax:513-770-3406
Practice Address - Street 1:5770 GATEWAY BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1896
Practice Address - Country:US
Practice Address - Phone:513-770-3405
Practice Address - Fax:513-770-3406
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1849111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0950725Medicaid
OHU42014Medicare UPIN
OHJO0734701Medicare ID - Type Unspecified