MEDICARE: DR. SCOTT D JONES D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038-009904	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00110684	OTHER	IL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	568230	OTHER	IL	HEALTHLINK
2	900068033	OTHER	IL	TAX-ID#
4	08220357	OTHER	IL	BCBS GRP#

General Provider Information

NPI Number	:	1053317388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT D JONES D.C.

Provider Business Mailing Address
First Line	:	2028 ROSEDALE CT
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-2637
Country	:	US
Telephone Number	:	314-544-7961
Fax Number	:

Provider Business Practice Location Address
First Line	:	2028 ROSEDALE CT
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-2637
Country	:	US
Telephone Number	:	314-544-7961
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	08/26/2008

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