Provider Demographics
NPI:1548242548
Name:MADIGAN, JASON T (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:T
Last Name:MADIGAN
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 1:8 N GROVE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-3547
Mailing Address - Country:US
Mailing Address - Phone:570-858-5645
Mailing Address - Fax:570-858-5687
Practice Address - Street 1:8 N GROVE ST
Practice Address - Street 2:SUITE B
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-3547
Practice Address - Country:US
Practice Address - Phone:570-858-5645
Practice Address - Fax:570-858-5687
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU99882Medicare UPIN
PA079287Medicare ID - Type Unspecified