Provider Demographics
NPI:1336177690
Name:SHERMAN, JASON LESLIE (DC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:LESLIE
Last Name:SHERMAN
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 1:902 W COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-1673
Mailing Address - Country:US
Mailing Address - Phone:507-532-3803
Mailing Address - Fax:507-532-3805
Practice Address - Street 1:902 W COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1673
Practice Address - Country:US
Practice Address - Phone:507-532-3803
Practice Address - Fax:507-532-3805
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDC3861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN27G84SHOtherBCBS
MN22414OtherSVHP
MN22414OtherSVHP