Provider Demographics
NPI:1033651906
Name:HOLT, JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:HOLT
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 1:1880 LANCASTER DR NE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1089
Mailing Address - Country:US
Mailing Address - Phone:503-589-0700
Mailing Address - Fax:503-586-0255
Practice Address - Street 1:1880 LANCASTER DR NE
Practice Address - Street 2:SUITE 107
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1089
Practice Address - Country:US
Practice Address - Phone:503-589-0700
Practice Address - Fax:503-586-0255
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor