Provider Demographics
NPI:1811055064
Name:ADAMS, JASON SAMUEL (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:SAMUEL
Last Name:ADAMS
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 1:7367 E CANTERBURY LN
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-8389
Mailing Address - Country:US
Mailing Address - Phone:208-442-6351
Mailing Address - Fax:
Practice Address - Street 1:7367 E CANTERBURY LN
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-8389
Practice Address - Country:US
Practice Address - Phone:208-442-6351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010142851OtherBLUE SHIELD
ID670357OtherUNITED HEALTH
IDC4686OtherBLUE CROSS
IDU94935Medicare UPIN
IDC4686OtherBLUE CROSS