Provider Demographics
NPI:1982143194
Name:JONES, ADAM (LMP)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6112 NE 104TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-5720
Mailing Address - Country:US
Mailing Address - Phone:360-936-0243
Mailing Address - Fax:
Practice Address - Street 1:14313 NE 20TH AVE
Practice Address - Street 2:SUITE A112
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-1487
Practice Address - Country:US
Practice Address - Phone:360-574-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60345448225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist