MEDICARE: DR. CHARLES DOUGLAS JONES D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3555	SC

General Provider Information

NPI Number	:	1447575212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES DOUGLAS JONES D.C.

Provider Business Mailing Address
First Line	:	11210 ASHEVILLE HWY
Second Line	:	SUITE # 2
City	:	INMAN
State	:	SC
Zip	:	29349-6786
Country	:	US
Telephone Number	:	864-472-0901
Fax Number	:	864-472-0902

Provider Business Practice Location Address
First Line	:	945 E MAIN ST
Second Line	:	SUITE # 5
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-2119
Country	:	US
Telephone Number	:	864-542-0780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2010
Last Update Date	:	02/02/2011

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