Provider Demographics
NPI:1649351420
Name:O'DESKY, JASON MARSHALL (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MARSHALL
Last Name:O'DESKY
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 1:1 MUNROE ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1506
Mailing Address - Country:US
Mailing Address - Phone:781-599-9500
Mailing Address - Fax:781-598-4480
Practice Address - Street 1:1 MUNROE ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1506
Practice Address - Country:US
Practice Address - Phone:781-599-9500
Practice Address - Fax:781-598-4480
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2849111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA50713OtherCHIROPRACTIC
MAY45676Medicare ID - Type UnspecifiedCHIROPRACTIC