Provider Demographics
NPI:1083985386
Name:JASA, KATIE JAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:JAN
Last Name:JASA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-1736
Mailing Address - Country:US
Mailing Address - Phone:402-560-2748
Mailing Address - Fax:
Practice Address - Street 1:935 8TH AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-1736
Practice Address - Country:US
Practice Address - Phone:308-254-1036
Practice Address - Fax:308-254-1199
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor