Provider Demographics
NPI:1619199411
Name:TEW, JASON E (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:E
Last Name:TEW
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 1:124 E BROAD ST
Mailing Address - Street 2:P.O. BOX 964
Mailing Address - City:CAMILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31730-1809
Mailing Address - Country:US
Mailing Address - Phone:229-336-2600
Mailing Address - Fax:229-336-2601
Practice Address - Street 1:124 E BROAD ST
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-1809
Practice Address - Country:US
Practice Address - Phone:229-336-2600
Practice Address - Fax:229-336-2601
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor