Provider Demographics
NPI:1215019922
Name:SMITH, JASON A (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:SMITH
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 1:1820 RICE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6810
Mailing Address - Country:US
Mailing Address - Phone:651-489-6550
Mailing Address - Fax:651-489-6556
Practice Address - Street 1:1820 RICE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-6810
Practice Address - Country:US
Practice Address - Phone:651-489-6550
Practice Address - Fax:651-489-6556
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN525171100000X
MN3356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN590716100Medicaid
MN553S1SMOtherBCBS
MN350002874Medicare ID - Type Unspecified
MN590716100Medicaid