Provider Demographics
NPI:1366438319
Name:CHESHIRE, JASON HUNTER (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:HUNTER
Last Name:CHESHIRE
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 1:4 NE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-6630
Mailing Address - Country:US
Mailing Address - Phone:954-943-1044
Mailing Address - Fax:954-943-1014
Practice Address - Street 1:4 NE 4TH AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6630
Practice Address - Country:US
Practice Address - Phone:954-943-1044
Practice Address - Fax:954-943-1014
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-11-28
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
FLCH0007622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55802ZOtherBC/BS
FL5336747OtherAETNA
FL55802ZMedicare PIN
FL5336747OtherAETNA