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General NPI Number Information
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NPI Number | 1962788158
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Entity Type | Individual
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Provider Name | RICHARD M. JONES M.S, ATC
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Gender | Male
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 02/04/2015
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Provider Practice Location Address
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Address Line | 300 ELM ST ATTN: ATHLETIC TRAINER
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City | ROCKFORD
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State | IL
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Zip | 61101-1238
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Country | US
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Telephone | 815-489-8298
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Fax | 815-380-6423
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Provider Business Mailing Address
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Address Line | 361 BIENTERRA TRAIL #8 ATTN: ATHLETIC TRAINER
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City | ROCKFORD
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State | IL
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Zip | 61107
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Country | US
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Telephone | 815-489-8298
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Fax | 815-380-6423
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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