Provider Demographics
NPI:1548218019
Name:STADTHER, JASON JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:JOHN
Last Name:STADTHER
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 1:2781 FREEWAY BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-1753
Mailing Address - Country:US
Mailing Address - Phone:763-244-8022
Mailing Address - Fax:763-244-8021
Practice Address - Street 1:2781 FREEWAY BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-1753
Practice Address - Country:US
Practice Address - Phone:763-244-8022
Practice Address - Fax:763-244-8021
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3945DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU85148Medicare UPIN