Provider Demographics
NPI:1558493676
Name:STROTHEIDE, JASON LOUIS (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:LOUIS
Last Name:STROTHEIDE
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 1:3412 NAMEOKI RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-3702
Mailing Address - Country:US
Mailing Address - Phone:618-876-7800
Mailing Address - Fax:
Practice Address - Street 1:3412 NAMEOKI RD
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-3702
Practice Address - Country:US
Practice Address - Phone:618-876-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK14400Medicare ID - Type Unspecified
T35450Medicare UPIN