Provider Demographics
NPI:1568540862
Name:JONES, JIMMIE LEON (DC)
Entity Type:Individual
Prefix:DR
First Name:JIMMIE
Middle Name:LEON
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 1:5122 PASADENA AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-2417
Mailing Address - Country:US
Mailing Address - Phone:810-733-0139
Mailing Address - Fax:810-733-0512
Practice Address - Street 1:5122 PASADENA AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2417
Practice Address - Country:US
Practice Address - Phone:810-733-0139
Practice Address - Fax:810-733-0512
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI14673140Medicaid
MI14673140Medicaid
MIOB55091Medicare ID - Type Unspecified