Provider Demographics
NPI:1760473516
Name:MENGES, JASON RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RICHARD
Last Name:MENGES
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 1:1416 MARTIN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2221
Mailing Address - Country:US
Mailing Address - Phone:410-877-1597
Mailing Address - Fax:
Practice Address - Street 1:516 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:410-638-2424
Practice Address - Fax:410-893-8923
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-01
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD225617OtherKAISER PROVIDER#
MDJ5830001OtherBLUE CHOICE/FEP #
MD640123OtherACN PROVIDER #
MD639A-HEOtherBCBS GROUP #
MD605923200OtherACS PROVIDER #
MD60485304OtherBCBS RENDERING ID#
MDU79715Medicare UPIN
MDO27N856FMedicare ID - Type UnspecifiedPROVIDER NUMBER
MDJ5830001OtherBLUE CHOICE/FEP #