Provider Demographics
NPI:1871862565
Name:CROWLEY, JASON (FNP, DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:CROWLEY
Suffix:
Gender:M
Credentials:FNP, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2877 LAKE TAHOE BLVD B
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7807
Mailing Address - Country:US
Mailing Address - Phone:530-307-2310
Mailing Address - Fax:
Practice Address - Street 1:2877 LAKE TAHOE BLVD B
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7807
Practice Address - Country:US
Practice Address - Phone:530-307-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-24
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32141111NN0400X
OR202002222363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111NN0400XChiropractic ProvidersChiropractorNeurology