Provider Demographics
NPI:1417232364
Name:RAESZ, JASON (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:RAESZ
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 1:2314 W ADAMS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-3937
Mailing Address - Country:US
Mailing Address - Phone:254-778-2225
Mailing Address - Fax:254-778-1600
Practice Address - Street 1:2314 W ADAMS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-3937
Practice Address - Country:US
Practice Address - Phone:254-778-2225
Practice Address - Fax:254-778-1600
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor