Provider Demographics
NPI:1376529388
Name:HENRY, JASON D (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:D
Last Name:HENRY
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-3245
Mailing Address - Country:US
Mailing Address - Phone:605-334-6656
Mailing Address - Fax:605-333-4875
Practice Address - Street 1:1727 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-3245
Practice Address - Country:US
Practice Address - Phone:605-334-6656
Practice Address - Fax:605-333-4875
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD980111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD20632OtherSIOUX VALLEY HEALTH PLAN
SDC980OtherDAKOTACARE
SD7594362OtherAETNA
SD6437OtherAVERA HEALTH PLANS
SD1594359OtherAMERICA'S PPO
SD4994635OtherBLUE CROSS
SDU89419Medicare UPIN
SD1594359OtherAMERICA'S PPO