Provider Demographics
NPI:1104917418
Name:JONES, GREGORY A (DC)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:A
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:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522
Mailing Address - Country:US
Mailing Address - Phone:610-944-9647
Mailing Address - Fax:610-944-8737
Practice Address - Street 1:14128 KUTZTOWN RD
Practice Address - Street 2:
Practice Address - City:FLEETWOOD
Practice Address - State:PA
Practice Address - Zip Code:19522
Practice Address - Country:US
Practice Address - Phone:610-944-9647
Practice Address - Fax:610-944-8737
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001574L111N00000X
MI2301004356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T28537Medicare UPIN
PA098058Medicare ID - Type Unspecified