Provider Demographics
NPI:1013080860
Name:HAMM, JASON ROGER (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ROGER
Last Name:HAMM
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 1:1330 LAKE STREET
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360
Mailing Address - Country:US
Mailing Address - Phone:712-336-5022
Mailing Address - Fax:712-336-5044
Practice Address - Street 1:1330 LAKE STREET
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360
Practice Address - Country:US
Practice Address - Phone:712-336-5022
Practice Address - Fax:712-336-5044
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5554111N00000X
IA06825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86-1016999OtherTAX ID NUMBER
AZZ64875Medicare ID - Type Unspecified