Provider Demographics
NPI:1720087497
Name:JONES, RICHARD RANDALL
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RANDALL
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S OAKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-1832
Mailing Address - Country:US
Mailing Address - Phone:724-346-3258
Mailing Address - Fax:
Practice Address - Street 1:175 N BUHL FARM DR
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-1752
Practice Address - Country:US
Practice Address - Phone:724-981-4550
Practice Address - Fax:724-981-6138
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001877L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA006199180002Medicaid
PAJ0023566Medicare ID - Type Unspecified
PAT27117Medicare UPIN