Provider Demographics
NPI:1629070248
Name:JONES, RICHARD A (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
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 1:9654 DETOUR RD
Mailing Address - Street 2:
Mailing Address - City:BUNKER HILL
Mailing Address - State:IL
Mailing Address - Zip Code:62014-2265
Mailing Address - Country:US
Mailing Address - Phone:618-585-3359
Mailing Address - Fax:618-585-3523
Practice Address - Street 1:721 S WASHINGTON ST
Practice Address - Street 2:POB 326
Practice Address - City:BUNKER HILL
Practice Address - State:IL
Practice Address - Zip Code:62014-1503
Practice Address - Country:US
Practice Address - Phone:618-585-3522
Practice Address - Fax:618-585-3523
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL11053830OtherCAQH
ILP00322481OtherRR MEDICARE
IL221133OtherPERSONAL CARE
IL38009532Medicaid
IL640063OtherACN
IL7691350001OtherONE HEALTH PLAN
IL197607OtherBC/BS MO
IL5932013OtherBC/BS ILLINOIS
IL11053830OtherCAQH
IL91254Medicare UPIN