Provider Demographics
NPI:1649456278
Name:MAGGIO, JASON L (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:L
Last Name:MAGGIO
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 1:8575 FERN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5676
Mailing Address - Country:US
Mailing Address - Phone:318-797-2587
Mailing Address - Fax:318-797-2588
Practice Address - Street 1:8575 FERN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5676
Practice Address - Country:US
Practice Address - Phone:318-797-2587
Practice Address - Fax:318-797-2588
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor