Provider Demographics
NPI:1083618813
Name:STANTON, JASON RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RYAN
Last Name:STANTON
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 1:1919 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2227
Mailing Address - Country:US
Mailing Address - Phone:316-321-9000
Mailing Address - Fax:316-321-1754
Practice Address - Street 1:1919 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2227
Practice Address - Country:US
Practice Address - Phone:316-321-9000
Practice Address - Fax:316-321-1754
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2018-01-19
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
KS4806111N00000X
KS01-04806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU94263Medicare UPIN
KS060967Medicare PIN