Provider Demographics
NPI:1952318198
Name:ABBOTT, JASON MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:MICHAEL
Last Name:ABBOTT
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 1:210 MARSH LANDING DR
Mailing Address - Street 2:APT. 301
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-4163
Mailing Address - Country:US
Mailing Address - Phone:757-814-3580
Mailing Address - Fax:
Practice Address - Street 1:2021A CUNNINGHAM DR
Practice Address - Street 2:SUITE 3
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3320
Practice Address - Country:US
Practice Address - Phone:757-838-8820
Practice Address - Fax:757-838-8823
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor