Provider Demographics
NPI:1780651240
Name:STANTON, JASON WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:WILLIAM
Last Name:STANTON
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 1:800 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3536
Mailing Address - Country:US
Mailing Address - Phone:337-367-2567
Mailing Address - Fax:337-367-2578
Practice Address - Street 1:4027 HIGHWAY 90 E
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-3509
Practice Address - Country:US
Practice Address - Phone:337-837-7174
Practice Address - Fax:337-837-7176
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAV05843Medicare UPIN
LA4H531D789Medicare ID - Type Unspecified