Provider Demographics
NPI:1063782456
Name:JONES, KJERSTEN JEAN (DC)
Entity type:Individual
Prefix:DR
First Name:KJERSTEN
Middle Name:JEAN
Last Name:JONES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 S ORCHARD ST
Mailing Address - Street 2:STE A
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-6722
Mailing Address - Country:US
Mailing Address - Phone:208-383-3703
Mailing Address - Fax:208-383-3702
Practice Address - Street 1:2300 S ORCHARD ST
Practice Address - Street 2:STE A
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-6722
Practice Address - Country:US
Practice Address - Phone:208-383-3703
Practice Address - Fax:208-383-3702
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1487111N00000X
MN5738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350005191OtherMEDICARE
MN1063782456Medicaid