Provider Demographics
NPI:1245871292
Name:DUNLAP, JASON DEAN (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DEAN
Last Name:DUNLAP
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 1:132 RIVER BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3833
Mailing Address - Country:US
Mailing Address - Phone:410-200-0029
Mailing Address - Fax:
Practice Address - Street 1:4 PEARL DR STE 1
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-1927
Practice Address - Country:US
Practice Address - Phone:386-390-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor