Provider Demographics
NPI:1760687024
Name:MINOGUE, JASON THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:THOMAS
Last Name:MINOGUE
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 1:5715 NW CENTRAL DR
Mailing Address - Street 2:SUITE F-111
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-2053
Mailing Address - Country:US
Mailing Address - Phone:713-690-4150
Mailing Address - Fax:
Practice Address - Street 1:5715 NW CENTRAL DR
Practice Address - Street 2:SUITE F-111
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-2053
Practice Address - Country:US
Practice Address - Phone:713-690-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.010831111N00000X
TX10719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB102461OtherMEDICARE