Provider Demographics
NPI:1225221518
Name:BLACK, JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:BLACK
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 1:8150 NORTH MACARTHUR BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063
Mailing Address - Country:US
Mailing Address - Phone:972-409-0016
Mailing Address - Fax:972-409-0013
Practice Address - Street 1:8150 N MACARTHUR BLVD STE 170
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4314
Practice Address - Country:US
Practice Address - Phone:972-409-0016
Practice Address - Fax:972-409-0013
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor