Provider Demographics
NPI:1831301514
Name:JAMES, JASON R (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:R
Last Name:JAMES
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 1:123 BOULEVARD RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-2318
Mailing Address - Country:US
Mailing Address - Phone:319-524-3339
Mailing Address - Fax:
Practice Address - Street 1:123 BOULEVARD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-2318
Practice Address - Country:US
Practice Address - Phone:319-524-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000175367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO151269OtherBLUECROSS BLUESHIELD
MO628249OtherUNITED HEALTHCARE
MO628249OtherUNITED HEALTHCARE