Healthcare Provider Details

I. General information

NPI: 1104539089
Provider Name (Legal Business Name): SAMANTHA JONES DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 HILL ST E
NORWOOD YOUNG AMERICA MN
55368-4565
US

IV. Provider business mailing address

PO BOX 215
NORWOOD YOUNG AMERICA MN
55368-0215
US

V. Phone/Fax

Practice location:
  • Phone: 952-467-2505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7042
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: