Provider Demographics
NPI:1235319997
Name:LAVALEY, JASON LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:LEE
Last Name:LAVALEY
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 1:835 S BURLINGTON AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-6960
Mailing Address - Country:US
Mailing Address - Phone:402-461-1171
Mailing Address - Fax:
Practice Address - Street 1:835 S BURLINGTON AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6960
Practice Address - Country:US
Practice Address - Phone:402-461-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-11
Last Update Date:2007-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor