Provider Demographics
NPI:1811964711
Name:HALL, JASON DURWOOD (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:DURWOOD
Last Name:HALL
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 1:8333 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6050
Mailing Address - Country:US
Mailing Address - Phone:850-474-8100
Mailing Address - Fax:850-474-8083
Practice Address - Street 1:8333 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6050
Practice Address - Country:US
Practice Address - Phone:850-474-8080
Practice Address - Fax:850-474-8082
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89418OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FL89418OtherFLORIDA BLUE
FL381803900Medicaid
AL592-03782OtherBCBS OF ALABAMA
V05710Medicare UPIN
FL89418OtherBLUE CROSS BLUE SHIELD OF FLORIDA