Provider Demographics
NPI:1013242742
Name:CARDINALI, JASON RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:RYAN
Last Name:CARDINALI
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 1:3823 W 12TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3381
Mailing Address - Country:US
Mailing Address - Phone:814-836-4663
Mailing Address - Fax:814-836-2711
Practice Address - Street 1:3823 W 12TH ST
Practice Address - Street 2:STE A
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3381
Practice Address - Country:US
Practice Address - Phone:814-836-4663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor