Provider Demographics
NPI:1780662866
Name:GILLIS, JASON ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ERIC
Last Name:GILLIS
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:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-0234
Mailing Address - Country:US
Mailing Address - Phone:724-625-3700
Mailing Address - Fax:724-625-3973
Practice Address - Street 1:441 MARS-VALENCIA RD.
Practice Address - Street 2:
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046
Practice Address - Country:US
Practice Address - Phone:724-625-3700
Practice Address - Fax:724-625-3973
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA073056Medicare ID - Type Unspecified
PAU96795Medicare UPIN