Provider Demographics
NPI:1194883850
Name:YUSAVAGE, JASON PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:PATRICK
Last Name:YUSAVAGE
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 1:514 BURKE BY-PASS
Mailing Address - Street 2:
Mailing Address - City:OLYPHANT
Mailing Address - State:PA
Mailing Address - Zip Code:18447
Mailing Address - Country:US
Mailing Address - Phone:570-489-9300
Mailing Address - Fax:570-489-2097
Practice Address - Street 1:514 BURKE BY-PASS
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447
Practice Address - Country:US
Practice Address - Phone:570-489-9300
Practice Address - Fax:570-489-2097
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007540L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
52899OtherGEISINGER
PA1011838660001Medicaid
7898494OtherAETNA
816961OtherFIRST PRIORITY
YU1524707OtherBLUE CROSS BLUE SHIELD
PA1011838660001Medicaid