Provider Demographics
NPI:1568430742
Name:JONES, GARY DAVID (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:DAVID
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 1:14003C N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2401
Mailing Address - Country:US
Mailing Address - Phone:813-963-3055
Mailing Address - Fax:813-969-1962
Practice Address - Street 1:14003C N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2401
Practice Address - Country:US
Practice Address - Phone:813-963-3055
Practice Address - Fax:813-969-1962
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0001565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89269OtherBCBS
FL209011200Medicaid
T56156Medicare UPIN
FL209011200Medicaid