Provider Demographics
NPI:1700607959
Name:JONES, CAELAN (DC)
Entity type:Individual
Prefix:
First Name:CAELAN
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 TAPESTRY PARK DR APT 208
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-9243
Mailing Address - Country:US
Mailing Address - Phone:803-235-5029
Mailing Address - Fax:
Practice Address - Street 1:10801 JOHNSTON RD STE 112
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-7855
Practice Address - Country:US
Practice Address - Phone:803-235-5029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor