Provider Demographics
NPI:1386804284
Name:PLACEWAY, JASON RANDALL (DC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:RANDALL
Last Name:PLACEWAY
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 1:455 DELTA AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-1127
Mailing Address - Country:US
Mailing Address - Phone:513-321-8484
Mailing Address - Fax:513-321-3676
Practice Address - Street 1:455 DELTA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45226-1127
Practice Address - Country:US
Practice Address - Phone:513-321-8484
Practice Address - Fax:513-321-3676
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3912111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0687065OtherMEDICAID GROUP NUMBER
OH4246771Medicare PIN