Provider Demographics
NPI:1770646838
Name:NEATHERLIN, JASON RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RAY
Last Name:NEATHERLIN
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 1:100 LA RUE FRANCE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3112
Mailing Address - Country:US
Mailing Address - Phone:337-237-2273
Mailing Address - Fax:337-237-1765
Practice Address - Street 1:100 LA RUE FRANCE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3112
Practice Address - Country:US
Practice Address - Phone:337-237-2273
Practice Address - Fax:337-237-1765
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007946111N00000X
LA1426111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor