Provider Demographics
NPI:1740460864
Name:JONES, MARK K (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:K
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 1:1000 ESSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-2841
Mailing Address - Country:US
Mailing Address - Phone:815-729-9711
Mailing Address - Fax:815-744-1681
Practice Address - Street 1:1000 ESSINGTON RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2841
Practice Address - Country:US
Practice Address - Phone:815-729-9711
Practice Address - Fax:815-744-1681
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0009982028OtherBCBS IL
IL612800Medicare PIN
ILT38515Medicare UPIN