Provider Demographics
NPI:1174837363
Name:ARDIS, JASON LANE (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:LANE
Last Name:ARDIS
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 1:7108 ENVOY CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-5102
Mailing Address - Country:US
Mailing Address - Phone:214-228-5149
Mailing Address - Fax:
Practice Address - Street 1:7108 ENVOY CT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-5102
Practice Address - Country:US
Practice Address - Phone:214-956-6995
Practice Address - Fax:214-956-6987
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor