Provider Demographics
NPI:1720382823
Name:JONES, MICHAEL ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
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 1:1209 N MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-8102
Mailing Address - Country:US
Mailing Address - Phone:217-483-2207
Mailing Address - Fax:217-483-3248
Practice Address - Street 1:1209 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-8102
Practice Address - Country:US
Practice Address - Phone:217-483-2207
Practice Address - Fax:217-483-3248
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT00675Medicare PIN