Provider Demographics
NPI:1851700736
Name:ARCH, JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:ARCH
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 1:962 SOUTH FOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720
Mailing Address - Country:US
Mailing Address - Phone:314-296-0157
Mailing Address - Fax:
Practice Address - Street 1:476 E MIDVALLEY RD
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721
Practice Address - Country:US
Practice Address - Phone:435-865-0917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4783663-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor