Provider Demographics
NPI:1023155439
Name:CROSS, JASON THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:THOMAS
Last Name:CROSS
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 1:4305 62ND ST E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-6663
Mailing Address - Country:US
Mailing Address - Phone:941-726-6235
Mailing Address - Fax:941-955-9944
Practice Address - Street 1:2831 RINGLING BLVD STE 101A
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5349
Practice Address - Country:US
Practice Address - Phone:941-955-8686
Practice Address - Fax:941-955-9944
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7411111N00000X
FLAP2259171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55705Medicare ID - Type Unspecified