Provider Demographics
NPI:1700916707
Name:MASTERS, JASON BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:BRIAN
Last Name:MASTERS
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 1:1824 WINGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2706
Mailing Address - Country:US
Mailing Address - Phone:407-788-0769
Mailing Address - Fax:
Practice Address - Street 1:3005 W LAKE MARY BLVD
Practice Address - Street 2:STE 101
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6060
Practice Address - Country:US
Practice Address - Phone:407-330-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 4972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70809Medicare PIN