Provider Demographics
NPI:1427124395
Name:HAAS, JASON WADE (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:WADE
Last Name:HAAS
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 1:1180 MAIN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-4709
Mailing Address - Country:US
Mailing Address - Phone:970-686-9117
Mailing Address - Fax:
Practice Address - Street 1:1180 MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-4709
Practice Address - Country:US
Practice Address - Phone:970-686-9117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO5441111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC510238Medicare PIN
COC512928Medicare PIN