Provider Demographics
NPI:1295805695
Name:PATTERSON, JASON ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ANTHONY
Last Name:PATTERSON
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 1:49 NATOMA ST
Mailing Address - Street 2:STE B
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2673
Mailing Address - Country:US
Mailing Address - Phone:916-985-4457
Mailing Address - Fax:916-985-4357
Practice Address - Street 1:49 NATOMA ST
Practice Address - Street 2:STE B
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2673
Practice Address - Country:US
Practice Address - Phone:916-985-4457
Practice Address - Fax:916-985-4357
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0291730Medicare ID - Type Unspecified