Provider Demographics
NPI:1730123654
Name:CERUTTI, JASON (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:CERUTTI
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 1:10000 AURORA HUDSON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236
Mailing Address - Country:US
Mailing Address - Phone:234-380-5351
Mailing Address - Fax:234-380-5710
Practice Address - Street 1:10000 AURORA HUDSON RD
Practice Address - Street 2:SUITE B
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236
Practice Address - Country:US
Practice Address - Phone:234-380-5351
Practice Address - Fax:234-380-5710
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00531300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
9074264OtherPIN PHCS
2281868OtherAETNA US HEALTHCARE
0177689000OtherAMERIHEALTH HMO POS
9074264OtherPIN PHCS