Provider Demographics
NPI:1477971711
Name:MCDONALD, JASON DEREK (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:DEREK
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22711 S ELLSWORTH RD STE G106
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6788
Mailing Address - Country:US
Mailing Address - Phone:480-264-6800
Mailing Address - Fax:480-300-4688
Practice Address - Street 1:22711 S ELLSWORTH RD # G106
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-6788
Practice Address - Country:US
Practice Address - Phone:480-264-6800
Practice Address - Fax:480-300-4688
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8350111NN1001X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition