Provider Demographics
NPI:1568505527
Name:DAWSON, JAY SCOTT (DC)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:SCOTT
Last Name:DAWSON
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:PO BOX 1881
Mailing Address - Street 2:1933 BELMONT LOOP, STUITE C
Mailing Address - City:WOODLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98674-1800
Mailing Address - Country:US
Mailing Address - Phone:360-225-5726
Mailing Address - Fax:360-225-2253
Practice Address - Street 1:1933 BELMONT LOOP STE C
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674-8492
Practice Address - Country:US
Practice Address - Phone:360-225-5726
Practice Address - Fax:360-225-2253
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8869083OtherGROUP MEDICARE PTAN
WA19266530OtherFEDERAL WORKERS COMP.
WA49239OtherWORKERS COMPENSATION
WA49239OtherWORKERS COMPENSATION
WA8869083OtherGROUP MEDICARE PTAN