Provider Demographics
NPI:1053300301
Name:NITZSCHE, JASON R (DC, PA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:NITZSCHE
Suffix:
Gender:M
Credentials:DC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-2850
Mailing Address - Country:US
Mailing Address - Phone:407-578-2225
Mailing Address - Fax:407-298-9605
Practice Address - Street 1:1009 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-2850
Practice Address - Country:US
Practice Address - Phone:407-578-2225
Practice Address - Fax:407-298-9605
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9054111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5980ZMedicare ID - Type UnspecifiedPROVIDER NUMBER
FLV06601Medicare UPIN