Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 7948 | TX |
NPI | 1407904899 |
---|---|
Provider Name | Ian Lee Jones III |
First Address | San Antonio, TX 78232-5052 |
Second Address | San Antonio, TX 78232-5052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 14/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200383974 | TAX ID (01) | TX |
752989296 | TAX ID (01) |