Provider Demographics
NPI:1790037414
Name:SCOPPA, JASON (DC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:SCOPPA
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 1:417 E PINE ST STE P
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2378
Mailing Address - Country:US
Mailing Address - Phone:479-283-9493
Mailing Address - Fax:206-708-6472
Practice Address - Street 1:417 E PINE ST STE P
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2378
Practice Address - Country:US
Practice Address - Phone:479-283-9493
Practice Address - Fax:206-708-6472
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60304341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor