Provider Demographics
NPI:1457445561
Name:GRUNDHAUSER, JASON J (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:J
Last Name:GRUNDHAUSER
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 1:4740 FLINTRIDGE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4254
Mailing Address - Country:US
Mailing Address - Phone:719-594-0071
Mailing Address - Fax:
Practice Address - Street 1:4740 FLINTRIDGE DR STE 101
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4254
Practice Address - Country:US
Practice Address - Phone:719-594-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO303486Medicare PIN
COC805209Medicare PIN