Provider Demographics
NPI:1780834259
Name:SHENLOOGIAN, JASON WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:WILLIAM
Last Name:SHENLOOGIAN
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 1:4146 S HARVARD
Mailing Address - Street 2:SUITE F-2
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4146 S HARVARD
Practice Address - Street 2:SUITE F-2
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2610
Practice Address - Country:US
Practice Address - Phone:918-933-5445
Practice Address - Fax:918-933-5446
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor