Provider Demographics
NPI:1518002971
Name:HARRE, JASON PAUL (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:PAUL
Last Name:HARRE
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 1:6150 DIAMOND CENTRE CT
Mailing Address - Street 2:SUITE 1003
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4368
Mailing Address - Country:US
Mailing Address - Phone:239-245-7909
Mailing Address - Fax:239-245-7981
Practice Address - Street 1:6150 DIAMOND CENTRE CT
Practice Address - Street 2:SUITE 1003
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4368
Practice Address - Country:US
Practice Address - Phone:239-245-7909
Practice Address - Fax:239-245-7981
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003031904111N00000X
FLCH11084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000025636Medicare ID - Type Unspecified
U98616Medicare UPIN