Provider Demographics
NPI:1790024230
Name:MENGE, JASON NORMAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:NORMAN
Last Name:MENGE
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 1:1320 KENWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2342
Mailing Address - Country:US
Mailing Address - Phone:218-728-3686
Mailing Address - Fax:218-728-2996
Practice Address - Street 1:115 WATERFRONT DRIVE
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-1525
Practice Address - Country:US
Practice Address - Phone:218-834-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor