Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3182-012 | WI |
NPI | 1003959529 |
---|---|
Provider Name | Dr. James Leslie Jones |
First Address | Randolph, WI 53956-1243 |
Second Address | Randolph, WI 53956-1243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 09/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U55831 | (02) | WI |