Provider Demographics
NPI:1598852840
Name:JONES, GREGG MOYLE (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:MOYLE
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:PO BOX 1415
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837
Mailing Address - Country:US
Mailing Address - Phone:509-765-0638
Mailing Address - Fax:509-765-3891
Practice Address - Street 1:411 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1716
Practice Address - Country:US
Practice Address - Phone:509-765-0638
Practice Address - Fax:509-765-3891
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA025202CH00003167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2029957Medicaid
WA0103392OtherDEPT OF LABOR AND INDUSTR
WA0205079OtherDEPT OF LABOR AND INDUSTR
WA0103392OtherDEPT OF LABOR AND INDUSTR