Provider Demographics
NPI:1366648214
Name:PELOQUIN, JASON JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:JAMES
Last Name:PELOQUIN
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 1:181 ADA DR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1416
Mailing Address - Country:US
Mailing Address - Phone:718-715-8211
Mailing Address - Fax:
Practice Address - Street 1:277 88TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5609
Practice Address - Country:US
Practice Address - Phone:718-833-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor