Provider Demographics
NPI:1326180704
Name:COONEY, JASON G (DC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:G
Last Name:COONEY
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 1:241 CROOKS AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1614
Mailing Address - Country:US
Mailing Address - Phone:973-772-5254
Mailing Address - Fax:973-772-2701
Practice Address - Street 1:241 CROOKS AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-1614
Practice Address - Country:US
Practice Address - Phone:973-772-5254
Practice Address - Fax:973-772-2701
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00586600111N00000X
NYX0102621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor