Provider Demographics
NPI:1063665842
Name:LAIRD, JASON EDWARD (BA, MSOM, LAC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:EDWARD
Last Name:LAIRD
Suffix:
Gender:M
Credentials:BA, MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 W COLLINS DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2448
Mailing Address - Country:US
Mailing Address - Phone:307-577-6333
Mailing Address - Fax:
Practice Address - Street 1:132 W COLLINS DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2448
Practice Address - Country:US
Practice Address - Phone:307-577-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC 00719171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist