Provider Demographics
NPI:1598837478
Name:GOLEC, JASON ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ROBERT
Last Name:GOLEC
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 1:4234 E WESTERN DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-5828
Mailing Address - Country:US
Mailing Address - Phone:928-646-7228
Mailing Address - Fax:928-634-7288
Practice Address - Street 1:4234 E WESTERN DR
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-5828
Practice Address - Country:US
Practice Address - Phone:928-646-7228
Practice Address - Fax:928-634-7288
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002289A111N00000X
AZ8311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200856870AMedicaid
IN250100COtherMEDICARE