Provider Demographics
NPI:1578529715
Name:LOPATE, JASON SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:SCOTT
Last Name:LOPATE
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 1:33550 S DIXIE HWY
Mailing Address - Street 2:SUITE 132
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034-5602
Mailing Address - Country:US
Mailing Address - Phone:305-242-6665
Mailing Address - Fax:305-242-6919
Practice Address - Street 1:33550 S DIXIE HWY
Practice Address - Street 2:SUITE 132
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-5602
Practice Address - Country:US
Practice Address - Phone:305-242-6665
Practice Address - Fax:305-242-6919
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382091200Medicaid
FLU80312Medicare UPIN