Provider Demographics
NPI:1689859076
Name:DR. JIMMIE L JONES DC PC
Entity Type:Organization
Organization Name:DR. JIMMIE L JONES DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-733-0139
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT82853Medicare UPIN