Provider Demographics
NPI:1376633784
Name:HART, JASON R (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:R
Last Name:HART
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 1:4367 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-3171
Mailing Address - Country:US
Mailing Address - Phone:334-558-0906
Mailing Address - Fax:334-558-0910
Practice Address - Street 1:4367 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-3171
Practice Address - Country:US
Practice Address - Phone:334-558-0906
Practice Address - Fax:334-558-0910
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051516135OtherBCBSAL
ALU91562Medicare UPIN
AL051516135Medicare ID - Type Unspecified