Provider Demographics
NPI:1750590659
Name:SHUMARD, JASON ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALAN
Last Name:SHUMARD
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 1:7094 MIRAMAR RD STE 109
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2311
Mailing Address - Country:US
Mailing Address - Phone:858-564-7081
Mailing Address - Fax:
Practice Address - Street 1:7094 MIRAMAR RD STE 109
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2311
Practice Address - Country:US
Practice Address - Phone:858-564-7081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29400111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29400Medicare ID - Type Unspecified