MEDICARE: DR. RUBERT PHILLIP 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	02906261202	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02906261202001	OTHER	UT	BLUE CROSS/BLUE SHIELD
2	02906261202	OTHER	UT	PEHP

General Provider Information

NPI Number	:	1821175001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBERT PHILLIP JONES D.C.

Provider Business Mailing Address
First Line	:	1828 E FT UNION BLVD
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3056
Country	:	US
Telephone Number	:	801-942-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1828 E FT UNION BLVD
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3056
Country	:	US
Telephone Number	:	801-942-9000
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	12/30/2011

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