Provider Demographics
NPI:1104539089
Name:JONES, SAMANTHA (DC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
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:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:NORWOOD YOUNG AMERICA
Mailing Address - State:MN
Mailing Address - Zip Code:55368-0215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:320 HILL ST E
Practice Address - Street 2:
Practice Address - City:NORWOOD YOUNG AMERICA
Practice Address - State:MN
Practice Address - Zip Code:55368-4565
Practice Address - Country:US
Practice Address - Phone:952-467-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor