Provider Demographics
NPI:1831239078
Name:OLLIS, JASON EVAN (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:EVAN
Last Name:OLLIS
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 1:10000 BROWNSBORO RD
Mailing Address - Street 2:STE 3
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-3900
Mailing Address - Country:US
Mailing Address - Phone:502-216-4497
Mailing Address - Fax:502-412-8862
Practice Address - Street 1:10000 BROWNSBORO RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-3900
Practice Address - Country:US
Practice Address - Phone:502-412-8580
Practice Address - Fax:502-412-8862
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7272Medicare ID - Type UnspecifiedGROUP NUMBER
KYU91612Medicare UPIN
KY0727201Medicare ID - Type UnspecifiedPROVIDER