Provider Demographics
NPI:1073740973
Name:CHARKALIS, JASON JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:JAMES
Last Name:CHARKALIS
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 1:188 SOUTH MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672-4375
Mailing Address - Country:US
Mailing Address - Phone:802-253-7004
Mailing Address - Fax:802-253-0867
Practice Address - Street 1:188 SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672-4375
Practice Address - Country:US
Practice Address - Phone:802-253-7004
Practice Address - Fax:802-253-0867
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0046452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor