Provider Demographics
NPI:1477592202
Name:HALTEMAN, JASON TODD (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:TODD
Last Name:HALTEMAN
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 1:600 ONWARD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-5927
Mailing Address - Country:US
Mailing Address - Phone:610-329-0973
Mailing Address - Fax:
Practice Address - Street 1:745 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-7519
Practice Address - Country:US
Practice Address - Phone:610-326-1967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007926L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA081361Medicare ID - Type Unspecified
PA083081Medicare UPIN