Provider Demographics
NPI:1972639557
Name:JONES, SAMMIE LEE JR (DC)
Entity Type:Individual
Prefix:
First Name:SAMMIE
Middle Name:LEE
Last Name:JONES
Suffix:JR
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:PO BOX 1040
Mailing Address - Street 2:
Mailing Address - City:ACKERMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39735-1040
Mailing Address - Country:US
Mailing Address - Phone:662-338-5446
Mailing Address - Fax:662-338-5349
Practice Address - Street 1:210 HIGHWAY 12 W
Practice Address - Street 2:SUITE D
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3708
Practice Address - Country:US
Practice Address - Phone:662-338-5446
Practice Address - Fax:662-338-5349
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0125428Medicaid
MS9015942Medicaid
MS94-3429344OtherEIN
MS9015942Medicaid
MS94-3429344OtherEIN