Provider Demographics
NPI:1003895079
Name:KASTER, JASON B (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:B
Last Name:KASTER
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 1:1791 BOY SCOUT DR STE 6
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2137
Mailing Address - Country:US
Mailing Address - Phone:239-821-0417
Mailing Address - Fax:239-936-2811
Practice Address - Street 1:1791 BOY SCOUT DR STE 6
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2137
Practice Address - Country:US
Practice Address - Phone:239-332-2555
Practice Address - Fax:239-332-2556
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
11-3716390OtherTAX ID STATE OF FLORIDA
FLCH8759OtherLIC
FL88573ZMedicare PIN
11-3716390OtherTAX ID STATE OF FLORIDA