Provider Demographics
NPI:1023131638
Name:HENKE, JASON (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HENKE
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 1:4220 A ST SE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-8620
Mailing Address - Country:US
Mailing Address - Phone:253-653-1858
Mailing Address - Fax:
Practice Address - Street 1:4220 A ST SE
Practice Address - Street 2:SUITE 203
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-8620
Practice Address - Country:US
Practice Address - Phone:253-653-1858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA01-0898348OtherTAX ID