Provider Demographics
NPI:1760511877
Name:STANCZAK, JASON AARON (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:AARON
Last Name:STANCZAK
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 1:30325 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-1714
Mailing Address - Country:US
Mailing Address - Phone:586-774-6301
Mailing Address - Fax:586-774-6350
Practice Address - Street 1:30325 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-1714
Practice Address - Country:US
Practice Address - Phone:586-774-6301
Practice Address - Fax:586-774-6350
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009010111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E00187OtherCHIROPRACTIC
MI0E00187OtherCHIROPRACTIC