Provider Demographics
NPI:1265989297
Name:DAVILA, JASON (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:DAVILA
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 1:4 PEARL ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-4149
Mailing Address - Country:US
Mailing Address - Phone:802-404-6000
Mailing Address - Fax:586-228-9019
Practice Address - Street 1:4 PEARL ST STE 103
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-4149
Practice Address - Country:US
Practice Address - Phone:802-404-6000
Practice Address - Fax:586-228-9019
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0117234111N00000X
MI2301010488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M35060Medicare PIN