Provider Demographics
NPI:1801810361
Name:DEGENHARDT, JASON A (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:DEGENHARDT
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 1:560 E CENTRAL TEXAS EXPY STE 102
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-5625
Mailing Address - Country:US
Mailing Address - Phone:254-698-1600
Mailing Address - Fax:254-698-1605
Practice Address - Street 1:560 E CENTRAL TEXAS EXPY STE 102
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-5625
Practice Address - Country:US
Practice Address - Phone:254-698-1600
Practice Address - Fax:254-698-1605
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M6299OtherBLUE CROSS BLUE SHIELD