Provider Demographics
NPI:1326008079
Name:JAEGER, JASON O (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:O
Last Name:JAEGER
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:PO BOX 401805
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140-1805
Mailing Address - Country:US
Mailing Address - Phone:702-396-4993
Mailing Address - Fax:702-636-4990
Practice Address - Street 1:6592 N DECATUR BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-1037
Practice Address - Country:US
Practice Address - Phone:702-396-4993
Practice Address - Fax:702-636-4990
Is Sole Proprietor?:No
Enumeration Date:2006-03-26
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00949111N00000X, 208100000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV39031OtherMEDICARE ID PART B
NVV04825Medicare UPIN