Provider Demographics
NPI:1619134954
Name:MAVOR, JASON HOLT (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:HOLT
Last Name:MAVOR
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 1:182 MAIN ST
Mailing Address - Street 2:MAVOR CHIROPRACTIC
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4409
Mailing Address - Country:US
Mailing Address - Phone:617-393-3472
Mailing Address - Fax:617-393-3473
Practice Address - Street 1:182 MAIN ST
Practice Address - Street 2:MAVOR CHIROPRACTIC
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4409
Practice Address - Country:US
Practice Address - Phone:617-393-3472
Practice Address - Fax:617-393-3473
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30920111N00000X
MA3254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor