Provider Demographics
NPI:1225660749
Name:CASTELLANOS, JASON (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:CASTELLANOS
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 1:5475 VINELAND RD APT 8314
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-7636
Mailing Address - Country:US
Mailing Address - Phone:786-351-4429
Mailing Address - Fax:
Practice Address - Street 1:1320 S ORLANDO AVE STE 3
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5556
Practice Address - Country:US
Practice Address - Phone:407-504-0117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor