Provider Demographics
NPI:1851684948
Name:PEISLEY, JASON JAMES ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:JAMES ROBERT
Last Name:PEISLEY
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 1:5215 MONROE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3190
Mailing Address - Country:US
Mailing Address - Phone:419-843-1515
Mailing Address - Fax:
Practice Address - Street 1:5215 MONROE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3190
Practice Address - Country:US
Practice Address - Phone:419-843-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor