Provider Demographics
NPI:1144594821
Name:KOLENDA, JASON LUDWIG (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LUDWIG
Last Name:KOLENDA
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 1:26540 CHIMNEY SPIRE LN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-4731
Mailing Address - Country:US
Mailing Address - Phone:386-871-2600
Mailing Address - Fax:
Practice Address - Street 1:26540 CHIMNEY SPIRE LN
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-4731
Practice Address - Country:US
Practice Address - Phone:386-871-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor