Provider Demographics
NPI:1285664987
Name:ULSRUD, JASON C (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:C
Last Name:ULSRUD
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 1:101 S FANNIN ST
Mailing Address - Street 2:SWEET 114
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-3775
Mailing Address - Country:US
Mailing Address - Phone:972-265-9508
Mailing Address - Fax:
Practice Address - Street 1:101 S FANNIN ST
Practice Address - Street 2:SUITE 114
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-3775
Practice Address - Country:US
Practice Address - Phone:972-265-9508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor