Provider Demographics
NPI:1386610046
Name:MACKEY, JASON J (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:J
Last Name:MACKEY
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 1:3070 FISH HATCHERY RD
Mailing Address - Street 2:STE 2
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53713-3187
Mailing Address - Country:US
Mailing Address - Phone:608-274-1945
Mailing Address - Fax:
Practice Address - Street 1:1173 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1672
Practice Address - Country:US
Practice Address - Phone:262-753-0017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38964600Medicaid
WI00535220Medicare ID - Type Unspecified
WI38964600Medicaid