Provider Demographics
NPI:1821220302
Name:WINNER, JASON DARE (MAOM, LAC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DARE
Last Name:WINNER
Suffix:
Gender:M
Credentials:MAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 LAUNFALL RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-2115
Mailing Address - Country:US
Mailing Address - Phone:610-834-9030
Mailing Address - Fax:
Practice Address - Street 1:250 W LANCASTER AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1743
Practice Address - Country:US
Practice Address - Phone:610-834-9030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAKO-000507171100000X
HIACU-772171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist