=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992996318
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JONES CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2007
-----------------------------------------------------
Last Update Date | 08/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 149 S LEONARD ST
-----------------------------------------------------
City | WEST SALEM
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54669-1620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-786-1426
-----------------------------------------------------
Fax | 608-786-0000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 149 S LEONARD ST
-----------------------------------------------------
City | WEST SALEM
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54669-1620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-786-1426
-----------------------------------------------------
Fax | 608-786-0000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DENISE LYNN JONES
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 608-786-1426
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3555
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------