Provider Demographics
NPI:1326147836
Name:ROSE, JASON R (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:R
Last Name:ROSE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:70 LAKE CONCORD RD NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-3057
Mailing Address - Country:US
Mailing Address - Phone:704-784-4445
Mailing Address - Fax:704-784-4335
Practice Address - Street 1:70 LAKE CONCORD RD NE
Practice Address - Street 2:SUITE 100
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-3057
Practice Address - Country:US
Practice Address - Phone:704-784-4445
Practice Address - Fax:704-784-4335
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC3529111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor