Provider Demographics
NPI:1912129016
Name:BLUMENFELD, JASON HENRY (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:HENRY
Last Name:BLUMENFELD
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 1:14 RONNIE'S PLAZA
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-3552
Mailing Address - Country:US
Mailing Address - Phone:314-843-0490
Mailing Address - Fax:314-843-9186
Practice Address - Street 1:14 RONNIE'S PLAZA
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-3552
Practice Address - Country:US
Practice Address - Phone:314-843-0490
Practice Address - Fax:314-843-9186
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO 6068111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO44-06969OtherUNITED HEALTH CARE
MO195026OtherHEALTHLINK HMO
MO4347363OtherAETNA
MO4282OtherANTHEM BCBS
MO195026OtherHELATHLINK PPO
MO32627OtherGHP COVENTRY
MO5502325002OtherCIGNA
MOU36099Medicare UPIN
MO195026OtherHELATHLINK PPO