Provider Demographics
NPI:1710088315
Name:MUBARAK, JASON GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:GEORGE
Last Name:MUBARAK
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 1:5076 SUNSET BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7050
Mailing Address - Country:US
Mailing Address - Phone:803-520-0084
Mailing Address - Fax:803-520-7284
Practice Address - Street 1:5076 SUNSET BLVD STE C
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7050
Practice Address - Country:US
Practice Address - Phone:803-520-0084
Practice Address - Fax:803-520-7284
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0944227576Medicare ID - Type Unspecified