Provider Demographics
NPI:1386069409
Name:SHERRELL, JASON LEE (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:LEE
Last Name:SHERRELL
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 1:3809 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2853
Mailing Address - Country:US
Mailing Address - Phone:509-263-3795
Mailing Address - Fax:509-464-0392
Practice Address - Street 1:3809 N MONROE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2853
Practice Address - Country:US
Practice Address - Phone:509-326-3795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61131051111N00000X
FLCH12700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACH61131051OtherWA CHIRO LICENSE NUMBER
WATT61158835OtherCHIROPRACTIC TEMPORARY LICENSE