Provider Demographics
NPI:1154534121
Name:WILLIAMS, JASON JUDE (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:JUDE
Last Name:WILLIAMS
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:PO BOX 1077
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-1077
Mailing Address - Country:US
Mailing Address - Phone:541-899-2760
Mailing Address - Fax:
Practice Address - Street 1:580 BLACKSTONE ALLEY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-1077
Practice Address - Country:US
Practice Address - Phone:541-899-2760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-3206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274976Medicaid
OR106465Medicare ID - Type Unspecified
OR274976Medicaid