Provider Demographics
NPI:1659484301
Name:JASON V WALP
Entity Type:Organization
Organization Name:JASON V WALP
Other - Org Name:CHRIROPRACTIC WELLNESS ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE DIRECTING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:VAUGHN
Authorized Official - Last Name:WALP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-882-6500
Mailing Address - Street 1:8913 CLEMENT AVENUE
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2603
Mailing Address - Country:US
Mailing Address - Phone:410-882-6500
Mailing Address - Fax:410-882-6640
Practice Address - Street 1:8913 CLEMENT AVENUE
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2603
Practice Address - Country:US
Practice Address - Phone:410-882-6500
Practice Address - Fax:410-882-6640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherEIN