Provider Demographics
NPI:1427460088
Name:JONES, MACKENZIE J (DC)
Entity type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:J
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 1:109 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:SURREY
Mailing Address - State:ND
Mailing Address - Zip Code:58785-7134
Mailing Address - Country:US
Mailing Address - Phone:701-721-8264
Mailing Address - Fax:
Practice Address - Street 1:1412 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3625
Practice Address - Country:US
Practice Address - Phone:701-721-8264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2019-02-18
Deactivation Date:2018-06-06
Deactivation Code:
Reactivation Date:2018-06-27
Provider Licenses
StateLicense IDTaxonomies
ND974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1474296Medicaid