Provider Demographics
NPI:1063544906
Name:SENECAL, JASON AZA (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:AZA
Last Name:SENECAL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JASON
Other - Middle Name:AZA
Other - Last Name:SENECAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:14135 CEDAR AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-4526
Mailing Address - Country:US
Mailing Address - Phone:952-432-5550
Mailing Address - Fax:952-432-0057
Practice Address - Street 1:14135 CEDAR AVE STE 400
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4526
Practice Address - Country:US
Practice Address - Phone:952-432-5550
Practice Address - Fax:952-432-0057
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN99D52CEOtherBLUE CROSS BLUE SHEILD
MN280448400Medicaid
MN895564OtherARAZ
MN350002498Medicare ID - Type Unspecified
MN99D52CEOtherBLUE CROSS BLUE SHEILD