Provider Demographics
NPI:1346277175
Name:NUTCHE, JASON ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALLEN
Last Name:NUTCHE
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 1:1608 WALNUT ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5457
Mailing Address - Country:US
Mailing Address - Phone:215-546-1010
Mailing Address - Fax:215-546-1005
Practice Address - Street 1:1608 WALNUT ST
Practice Address - Street 2:SUITE 601
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5457
Practice Address - Country:US
Practice Address - Phone:215-546-1010
Practice Address - Fax:215-546-1005
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010447111NT0100X
PADC009649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NT0100XChiropractic ProvidersChiropractorThermography
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01132008OtherBLUE CROSS/BLUE SHIELD
212196Medicare UPIN
IL213005Medicare ID - Type Unspecified