Provider Demographics
NPI:1932676624
Name:THOMSEN, JASON TUCKER (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:TUCKER
Last Name:THOMSEN
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 1:57 E 800 N
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1210
Mailing Address - Country:US
Mailing Address - Phone:801-798-7176
Mailing Address - Fax:863-293-0078
Practice Address - Street 1:57 E 800 N
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1210
Practice Address - Country:US
Practice Address - Phone:801-798-7176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12596111N00000X
UT13222504-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor