Provider Demographics
NPI:1104905165
Name:DOZARK, JASON (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:DOZARK
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 1:11818 SE MILL PLAIN BLVD
Mailing Address - Street 2:#408
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5089
Mailing Address - Country:US
Mailing Address - Phone:360-254-0616
Mailing Address - Fax:360-254-0618
Practice Address - Street 1:11818 SE MILL PLAIN BLVD
Practice Address - Street 2:#408
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5089
Practice Address - Country:US
Practice Address - Phone:360-254-0616
Practice Address - Fax:360-254-0618
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH34345111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU99566Medicare UPIN
WA8803153Medicare ID - Type Unspecified