Provider Demographics
NPI:1952311359
Name:JONES, PHILIP DEREK (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DEREK
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 1:1307 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-3811
Mailing Address - Country:US
Mailing Address - Phone:501-843-2222
Mailing Address - Fax:501-843-2277
Practice Address - Street 1:1307 S PINE ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-3811
Practice Address - Country:US
Practice Address - Phone:501-843-2222
Practice Address - Fax:501-843-2277
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X121C705OtherMEDICARE OTHER
AR148748718Medicaid
AR5X121Medicare ID - Type UnspecifiedPROVIDER NUMBER
AR5X121C705OtherMEDICARE OTHER