Provider Demographics
NPI:1801846878
Name:GUTZWILER, JASON D (DC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:D
Last Name:GUTZWILER
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 1:298 S MAIN ST STE 208
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2416
Mailing Address - Country:US
Mailing Address - Phone:509-684-7640
Mailing Address - Fax:509-684-7640
Practice Address - Street 1:298 S MAIN ST STE 208
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2416
Practice Address - Country:US
Practice Address - Phone:509-684-7640
Practice Address - Fax:509-684-7640
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8929165Medicare UPIN
WAG8860380Medicare PIN