Provider Demographics
NPI:1780681577
Name:SPROWLS, JONAS R (D C)
Entity Type:Individual
Prefix:DR
First Name:JONAS
Middle Name:R
Last Name:SPROWLS
Suffix:
Gender:M
Credentials:D C
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 177
Mailing Address - Street 2:104 N INDIAN MERIDIAN RD
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-0177
Mailing Address - Country:US
Mailing Address - Phone:405-238-4888
Mailing Address - Fax:405-238-2103
Practice Address - Street 1:104 INDIAN MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075
Practice Address - Country:US
Practice Address - Phone:405-238-4888
Practice Address - Fax:405-238-2103
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKV00440Medicare UPIN
244515302Medicare ID - Type Unspecified