Provider Demographics
NPI:1528458908
Name:JEWELL, JASON MARTIN (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MARTIN
Last Name:JEWELL
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 1:4233 NORTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6251
Mailing Address - Country:US
Mailing Address - Phone:561-425-5489
Mailing Address - Fax:772-905-2550
Practice Address - Street 1:4233 NORTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6251
Practice Address - Country:US
Practice Address - Phone:561-425-5489
Practice Address - Fax:772-905-2550
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014436300Medicaid