Provider Demographics
NPI:1710181623
Name:KOLBER, JASON M (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:M
Last Name:KOLBER
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 1:4221 E CHANDLER BLVD
Mailing Address - Street 2:SUITE #114
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8874
Mailing Address - Country:US
Mailing Address - Phone:480-704-2787
Mailing Address - Fax:480-704-2788
Practice Address - Street 1:4221 E CHANDLER BLVD
Practice Address - Street 2:SUITE #114
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8874
Practice Address - Country:US
Practice Address - Phone:480-704-2787
Practice Address - Fax:480-704-2788
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5903111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0248900OtherBCBS
AZ69052Medicare PIN
AZU88571Medicare UPIN