Provider Demographics
NPI:1396216149
Name:KRANTZ, JASON (LAC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:KRANTZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 N 3RD ST # 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-2113
Mailing Address - Country:US
Mailing Address - Phone:484-466-9355
Mailing Address - Fax:
Practice Address - Street 1:16 N 3RD ST # 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2113
Practice Address - Country:US
Practice Address - Phone:484-466-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001160171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist