Provider Demographics
NPI:1841311594
Name:JASON SHUMARD, A CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:JASON SHUMARD, A CHIROPRACTIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SHUMARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-564-7081
Mailing Address - Street 1:6904 MIRAMAR RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2617
Mailing Address - Country:US
Mailing Address - Phone:858-564-7081
Mailing Address - Fax:
Practice Address - Street 1:6904 MIRAMAR RD
Practice Address - Street 2:SUITE 214
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2617
Practice Address - Country:US
Practice Address - Phone:858-564-7081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29400Medicare ID - Type Unspecified