Provider Demographics
NPI:1699894139
Name:GREGORY A. JONES DC PC
Entity type:Organization
Organization Name:GREGORY A. JONES DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DC PC
Authorized Official - Phone:610-944-9647
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001574L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28537Medicare UPIN
PA098058Medicare PIN