Provider Demographics
NPI:1790900991
Name:JONES, BERNARD SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:SCOTT
Last Name:JONES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:B
Other - Middle Name:SCOTT
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:11811 MUKILTEO SPEEDWAY
Mailing Address - Street 2:105
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5442
Mailing Address - Country:US
Mailing Address - Phone:425-348-3400
Mailing Address - Fax:425-710-4030
Practice Address - Street 1:11811 MUKILTEO SPEEDWAY
Practice Address - Street 2:105
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5442
Practice Address - Country:US
Practice Address - Phone:425-348-3400
Practice Address - Fax:425-710-4030
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA102520OtherLABOR & INDUSTRIES
WA102520OtherLABOR & INDUSTRIES
AB02035Medicare ID - Type Unspecified