Provider Demographics
NPI:1821238700
Name:DAVIDSON, JASON WESLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:WESLEY
Last Name:DAVIDSON
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 1:200 MEADOW OAK TRL
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-1467
Mailing Address - Country:US
Mailing Address - Phone:612-802-0865
Mailing Address - Fax:
Practice Address - Street 1:21075 SWENSON DR
Practice Address - Street 2:SUITE 700
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-2000
Practice Address - Country:US
Practice Address - Phone:612-802-0865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4466-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor