Provider Demographics
NPI:1124369988
Name:VANCE, JASON RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RYAN
Last Name:VANCE
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 1:5383 W AUTUMN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6495
Mailing Address - Country:US
Mailing Address - Phone:801-662-8366
Mailing Address - Fax:
Practice Address - Street 1:11762 S STATE ST
Practice Address - Street 2:SUITE 320
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7155
Practice Address - Country:US
Practice Address - Phone:801-312-9991
Practice Address - Fax:801-312-9979
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8589999-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor