Provider Demographics
NPI:1982758371
Name:JONES, BRIAN (DC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
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 1:17090 AVONDALE WAY NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4409
Mailing Address - Country:US
Mailing Address - Phone:425-882-0802
Mailing Address - Fax:425-882-2331
Practice Address - Street 1:17090 AVONDALE WAY NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4409
Practice Address - Country:US
Practice Address - Phone:425-882-0802
Practice Address - Fax:425-882-2331
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034529111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0206061OtherL&I
WA8858356Medicare ID - Type Unspecified