Healthcare Provider Details

I. General information

NPI: 1447471537
Provider Name (Legal Business Name): STEPHEN A. JONES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 WYCKOFF AVENUE SUITE 201
WALDWICK NJ
07463
US

IV. Provider business mailing address

18 WYCKOFF AVENUE SUITE 201
WALDWICK NJ
07463
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-5757
  • Fax: 201-447-5750
Mailing address:
  • Phone: 201-447-5757
  • Fax: 201-447-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00584200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN A. JONES
Title or Position: OWNER
Credential: D.C.
Phone: 201-447-5757