Provider Demographics
NPI:1598810160
Name:BAIETTO, JASON J (DC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:J
Last Name:BAIETTO
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 1:206 S PLACENTIA AVE
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5710
Mailing Address - Country:US
Mailing Address - Phone:714-572-9555
Mailing Address - Fax:714-986-9600
Practice Address - Street 1:206 S PLACENTIA AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5710
Practice Address - Country:US
Practice Address - Phone:714-572-9555
Practice Address - Fax:714-986-9600
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27386111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27386Medicare ID - Type UnspecifiedCHIROPRACTIC