Provider Demographics
NPI:1932216959
Name:JONES, LARRY L (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:L
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 1:1516 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YANKTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57078
Mailing Address - Country:US
Mailing Address - Phone:605-665-9343
Mailing Address - Fax:
Practice Address - Street 1:1516 BROADWAY
Practice Address - Street 2:
Practice Address - City:YANKTOWN
Practice Address - State:SD
Practice Address - Zip Code:57078
Practice Address - Country:US
Practice Address - Phone:605-665-9343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7603410Medicaid
SD7603410Medicaid