Provider Demographics
NPI:1245237189
Name:BOLLENBAUGH, JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:BOLLENBAUGH
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 1:2191 HILLSBORO RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-6223
Mailing Address - Country:US
Mailing Address - Phone:618-420-0409
Mailing Address - Fax:615-465-6682
Practice Address - Street 1:2191 HILLSBORO RD
Practice Address - Street 2:SUITE A
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37069-6223
Practice Address - Country:US
Practice Address - Phone:618-420-0409
Practice Address - Fax:615-465-6682
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009505111N00000X
TN2614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210868001OtherMEDICARE PTAN - INDIVIDUAL
IL681087OtherUHC#
IL7521142OtherBC/BS GROUP MCC
IL620543OtherHEALTHLINK
IL210868OtherMEDICARE GROUP - MCC
IL37-1361254OtherTAX ID - MCC
IL601151600OtherUS DEPT OF LABOR
IL681087OtherUHC#