Provider Demographics
NPI:1235222332
Name:TRIPP, JASON C (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:C
Last Name:TRIPP
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 1:2160 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-2728
Mailing Address - Country:US
Mailing Address - Phone:724-342-5503
Mailing Address - Fax:724-342-5990
Practice Address - Street 1:2160 E STATE ST
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-2728
Practice Address - Country:US
Practice Address - Phone:724-342-5503
Practice Address - Fax:724-342-5990
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019531240001Medicaid
PA1528661OtherGATEWAY
PA158438100OtherOWCP
PA224556OtherHEALTH ASSURANCE
PAP00217405OtherRAILROAD MEDICARE
PA325563OtherUPMC
PA0019531240001Medicaid
PA069209WS9Medicare PIN