Provider Demographics
NPI:1770700122
Name:DR. JASON J. KOENIG, P.C.
Entity type:Organization
Organization Name:DR. JASON J. KOENIG, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-985-9888
Mailing Address - Street 1:2100 DATA PARK
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2519
Mailing Address - Country:US
Mailing Address - Phone:205-985-9888
Mailing Address - Fax:205-985-9895
Practice Address - Street 1:2100 DATA PARK
Practice Address - Street 2:SUITE 100
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2519
Practice Address - Country:US
Practice Address - Phone:205-985-9888
Practice Address - Fax:205-985-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51507455Medicare ID - Type Unspecified
ALU59919Medicare UPIN