Provider Demographics
NPI:1306811310
Name:CLEWIS, JASON DALE (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:DALE
Last Name:CLEWIS
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 1:315 PAGE RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8751
Mailing Address - Country:US
Mailing Address - Phone:910-295-1215
Mailing Address - Fax:910-295-1814
Practice Address - Street 1:315 PAGE RD
Practice Address - Street 2:SUITE 11
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8751
Practice Address - Country:US
Practice Address - Phone:910-295-1215
Practice Address - Fax:910-295-1814
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor