Provider Demographics
NPI:1295710424
Name:NOTTGER, JASON DUANE (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:DUANE
Last Name:NOTTGER
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 1:2808 MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-9562
Mailing Address - Country:US
Mailing Address - Phone:812-275-0500
Mailing Address - Fax:812-275-3500
Practice Address - Street 1:2808 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-9562
Practice Address - Country:US
Practice Address - Phone:812-275-0500
Practice Address - Fax:812-275-3500
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN81000080A171100000X
IN08002094A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1295710424Medicare PIN
U84110Medicare UPIN