Provider Demographics
NPI:1104154442
Name:CULP, JASON DAVID (ND)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:DAVID
Last Name:CULP
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3 POMPERAUG OFFICE PARK
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2287
Mailing Address - Country:US
Mailing Address - Phone:203-264-3583
Mailing Address - Fax:203-264-5102
Practice Address - Street 1:3 POMPERAUG OFFICE PARK
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2287
Practice Address - Country:US
Practice Address - Phone:203-264-3583
Practice Address - Fax:203-264-5102
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT 60121435175F00000X
CT000473175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath