Provider Demographics
NPI:1528307642
Name:ROURKE, JASON LEE (BS, DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:LEE
Last Name:ROURKE
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WATERFORD ST
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412
Mailing Address - Country:US
Mailing Address - Phone:814-730-2666
Mailing Address - Fax:814-286-9420
Practice Address - Street 1:106 WATERFORD ST
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412
Practice Address - Country:US
Practice Address - Phone:814-730-2666
Practice Address - Fax:814-286-9420
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010698111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor