Provider Demographics
NPI:1952633125
Name:PEASE, JASON CORDOVA (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:CORDOVA
Last Name:PEASE
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 1:293 ROCKIN HILL DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6655
Mailing Address - Country:US
Mailing Address - Phone:678-379-7141
Mailing Address - Fax:
Practice Address - Street 1:11925 JONES BRIDGE RD
Practice Address - Street 2:SUITE103
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-5076
Practice Address - Country:US
Practice Address - Phone:678-379-7141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008605111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation