Provider Demographics
NPI:1154418929
Name:SYREK, JASON A (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:SYREK
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 1:5757 CAPITOL BLVD SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501
Mailing Address - Country:US
Mailing Address - Phone:360-357-5222
Mailing Address - Fax:
Practice Address - Street 1:5983 W STATE ST STE B
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-3055
Practice Address - Country:US
Practice Address - Phone:208-408-3544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033952111N00000X
IDCHIA-2020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB29603Medicare ID - Type UnspecifiedGROUP
WAAB29602Medicare PIN