Provider Demographics
NPI:1063486355
Name:VILLALOBOS, JASON J (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:J
Last Name:VILLALOBOS
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 1:102 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-2522
Mailing Address - Country:US
Mailing Address - Phone:515-962-2166
Mailing Address - Fax:515-962-2177
Practice Address - Street 1:102 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-2522
Practice Address - Country:US
Practice Address - Phone:515-962-2166
Practice Address - Fax:515-962-2177
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0212464Medicaid
IA0212464Medicaid
U81142Medicare UPIN