Provider Demographics
NPI:1013925916
Name:JONES, GLENN HAROLD (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:HAROLD
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 1:1406 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:FT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4706
Mailing Address - Country:US
Mailing Address - Phone:772-464-3831
Mailing Address - Fax:772-468-8921
Practice Address - Street 1:1406 S 25TH ST
Practice Address - Street 2:
Practice Address - City:FT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4706
Practice Address - Country:US
Practice Address - Phone:772-464-3831
Practice Address - Fax:772-468-8921
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
88194Medicare ID - Type Unspecified
T85823Medicare UPIN