Provider Demographics
NPI:1396851457
Name:AVELAR, JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:AVELAR
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 1:14300 N. NORTHSIGHT BLVD
Mailing Address - Street 2:STE. 116
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-607-9779
Mailing Address - Fax:480-607-5804
Practice Address - Street 1:14300 N. NORTHSIGHT BLVD
Practice Address - Street 2:STE. 116
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:480-607-9779
Practice Address - Fax:480-607-5804
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009830111N00000X
AZ8128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02230328OtherBCBS
IL02230328OtherBCBS