Provider Demographics
NPI:1073601837
Name:BEMIS, JARED G (DC)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:G
Last Name:BEMIS
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 1:6040 LIBRARY RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102
Mailing Address - Country:US
Mailing Address - Phone:412-831-2225
Mailing Address - Fax:412-831-0192
Practice Address - Street 1:6040 LIBRARY RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102
Practice Address - Country:US
Practice Address - Phone:412-831-2225
Practice Address - Fax:412-831-0192
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA090506LZLMedicare ID - Type Unspecified
V04835Medicare UPIN