Provider Demographics
NPI:1003079716
Name:TAGAI, JASON DENNIS (DOCTOR OF CHIROPRACT)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:DENNIS
Last Name:TAGAI
Suffix:
Gender:M
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
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Mailing Address - Street 1:28041 CARRIAGE WAY DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2101
Mailing Address - Country:US
Mailing Address - Phone:586-948-7246
Mailing Address - Fax:586-948-2748
Practice Address - Street 1:28041 CARRIAGE WAY DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2101
Practice Address - Country:US
Practice Address - Phone:586-948-7246
Practice Address - Fax:586-948-2748
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor