Provider Demographics
NPI:1548429772
Name:SUNDERLAND, JASON MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:MATTHEW
Last Name:SUNDERLAND
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 1:407 MEADOWVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-3522
Mailing Address - Country:US
Mailing Address - Phone:318-371-9979
Mailing Address - Fax:318-371-9949
Practice Address - Street 1:407 MEADOWVIEW DR
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3522
Practice Address - Country:US
Practice Address - Phone:318-371-9979
Practice Address - Fax:318-371-9949
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor