Provider Demographics
NPI:1932283637
Name:DRIVERE, JASON DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:DAVID
Last Name:DRIVERE
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 1:3950 NEW CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:PA
Mailing Address - Zip Code:16143-1206
Mailing Address - Country:US
Mailing Address - Phone:724-977-1570
Mailing Address - Fax:
Practice Address - Street 1:212 W VINE ST
Practice Address - Street 2:
Practice Address - City:NEW WILMINGTON
Practice Address - State:PA
Practice Address - Zip Code:16142-1206
Practice Address - Country:US
Practice Address - Phone:724-946-9410
Practice Address - Fax:724-946-9411
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009266111N00000X
OH3537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7432637OtherAETNA
PA1055654OtherAMERICAN SPEC. HEALTH
PA720816OtherUPMC
PA695320OtherACN
PA1017114200001Medicaid
PA421611217OtherHEALTH AMERICA/ASSURANCE
PA001638338OtherHIGHMARK BC/BS
PA6882206OtherCIGNA
PA084189Medicare ID - Type Unspecified