Provider Demographics
NPI:1477527976
Name:JONES, ELIZABETH WATTS (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:WATTS
Last Name:JONES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 N ATLANTIC AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-3886
Mailing Address - Country:US
Mailing Address - Phone:321-868-0888
Mailing Address - Fax:321-868-3468
Practice Address - Street 1:6615 N ATLANTIC AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CAPE CANAVERAL
Practice Address - State:FL
Practice Address - Zip Code:32920-3886
Practice Address - Country:US
Practice Address - Phone:321-868-0888
Practice Address - Fax:321-868-3468
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055439100Medicaid
FL22678Medicare ID - Type Unspecified
FLU20639Medicare UPIN