Provider Demographics
NPI:1801044110
Name:OTTIS, JASON T (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:T
Last Name:OTTIS
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 1:6449 N COSBY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2378
Mailing Address - Country:US
Mailing Address - Phone:816-741-8422
Mailing Address - Fax:816-741-8423
Practice Address - Street 1:6449 N COSBY AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2378
Practice Address - Country:US
Practice Address - Phone:816-741-8422
Practice Address - Fax:816-741-8423
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009005935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor