Provider Demographics
NPI:1477076545
Name:FAIPLER, JASON THOMAS (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:THOMAS
Last Name:FAIPLER
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 1:11017 BLUE MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-2901
Mailing Address - Country:US
Mailing Address - Phone:814-392-2228
Mailing Address - Fax:
Practice Address - Street 1:3440 CONWAY BLVD STE 3B
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-7050
Practice Address - Country:US
Practice Address - Phone:941-766-1882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor