Provider Demographics
NPI:1043429616
Name:EPENETER, JASON MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:MICHAEL
Last Name:EPENETER
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 1:715 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-2514
Mailing Address - Country:US
Mailing Address - Phone:253-722-3437
Mailing Address - Fax:253-683-3001
Practice Address - Street 1:715 N 12TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-2514
Practice Address - Country:US
Practice Address - Phone:253-722-3437
Practice Address - Fax:253-683-3001
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28066111N00000X
WA34081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor