Provider Demographics
NPI:1356568620
Name:ROW, JASON L (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:L
Last Name:ROW
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 1:7411 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63143-3031
Mailing Address - Country:US
Mailing Address - Phone:314-752-1155
Mailing Address - Fax:314-781-1374
Practice Address - Street 1:7411 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63143-3031
Practice Address - Country:US
Practice Address - Phone:314-752-1155
Practice Address - Fax:314-781-1374
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000143618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO155458OtherANTHEM BCBS