Provider Demographics
NPI:1114080124
Name:JASON WALTER WINSECK CASCADES CHIROPRACTIC
Entity Type:Organization
Organization Name:JASON WALTER WINSECK CASCADES CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:WINSECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-404-0350
Mailing Address - Street 1:45591 DULLES EASTERN PLZ
Mailing Address - Street 2:STE 132
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-8925
Mailing Address - Country:US
Mailing Address - Phone:703-404-0350
Mailing Address - Fax:703-404-0352
Practice Address - Street 1:45591 DULLES EASTERN PLZ
Practice Address - Street 2:STE 132
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8925
Practice Address - Country:US
Practice Address - Phone:703-404-0350
Practice Address - Fax:703-404-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350001259Medicare ID - Type Unspecified