Provider Demographics
NPI:1568437952
Name:SOTHMAN, JASON JOHN (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:JOHN
Last Name:SOTHMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:J
Other - Last Name:SOTHMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:213 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2535
Mailing Address - Country:US
Mailing Address - Phone:641-682-8800
Mailing Address - Fax:
Practice Address - Street 1:213 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2535
Practice Address - Country:US
Practice Address - Phone:641-682-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA24707OtherBC/BS
IA350051184OtherRAILROAD MEDICARE
IA1162255Medicaid
IAI1439Medicare ID - Type Unspecified
IA1162255Medicaid