Healthcare Provider Details

I. General information

NPI: 1821681693
Provider Name (Legal Business Name): KAITLYN JONES DC, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CIDER CT
EAST BRUNSWICK NJ
08816-2803
US

IV. Provider business mailing address

100 CENTER ST
WALLINGFORD CT
06492-4112
US

V. Phone/Fax

Practice location:
  • Phone: 973-897-2906
  • Fax:
Mailing address:
  • Phone: 973-897-2906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2285
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number1494
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: