Provider Demographics
NPI:1851631873
Name:CALDWELL, JASON JONAS (DOM)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:JONAS
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 E. MCKELLIPS RD.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215
Mailing Address - Country:US
Mailing Address - Phone:480-370-0527
Mailing Address - Fax:480-534-5927
Practice Address - Street 1:6025 E. MCKELLIPS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215
Practice Address - Country:US
Practice Address - Phone:480-370-0527
Practice Address - Fax:480-534-5927
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3431171100000X
AZ1013171100000X
AZAPLAC1013171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist