Provider Demographics
NPI:1518948538
Name:JONES, ROGER CHRISTOPHER (DC)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:CHRISTOPHER
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 1:2306 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:KY
Mailing Address - Zip Code:41071-3234
Mailing Address - Country:US
Mailing Address - Phone:859-572-0029
Mailing Address - Fax:859-572-0263
Practice Address - Street 1:2306 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:KY
Practice Address - Zip Code:41071-3234
Practice Address - Country:US
Practice Address - Phone:859-572-0029
Practice Address - Fax:859-572-0263
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001436Medicaid
KY85001436Medicaid