Provider Demographics
NPI:1114022696
Name:EDWARDS, JASON ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALAN
Last Name:EDWARDS
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 1:940 W SAN MARCOS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1120
Mailing Address - Country:US
Mailing Address - Phone:760-744-1881
Mailing Address - Fax:760-744-2103
Practice Address - Street 1:940 W SAN MARCOS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1120
Practice Address - Country:US
Practice Address - Phone:760-744-1881
Practice Address - Fax:760-744-2103
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U50869Medicare UPIN
CADC23245Medicare ID - Type Unspecified