Provider Demographics
NPI:1306932298
Name:MCRAE, JASON DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:DAVID
Last Name:MCRAE
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 1:4210 COLUMBIA RD STE 5A
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0453
Mailing Address - Country:US
Mailing Address - Phone:706-869-7474
Mailing Address - Fax:
Practice Address - Street 1:4210 COLUMBIA RD STE 5A
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0453
Practice Address - Country:US
Practice Address - Phone:706-869-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHR007716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor