Provider Demographics
NPI:1649818345
Name:JASON M JEWELL, DC, PA
Entity type:Organization
Organization Name:JASON M JEWELL, DC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-900-4327
Mailing Address - Street 1:123 DATE PALM DR
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-3571
Mailing Address - Country:US
Mailing Address - Phone:561-900-4327
Mailing Address - Fax:772-905-2550
Practice Address - Street 1:4223 NORTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6251
Practice Address - Country:US
Practice Address - Phone:561-900-4327
Practice Address - Fax:772-905-2550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014436300Medicaid