Provider Demographics
NPI:1558509778
Name:BARTON, JASON JOHN
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:JOHN
Last Name:BARTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 GUNDERMAN RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-8624
Mailing Address - Country:US
Mailing Address - Phone:315-573-3173
Mailing Address - Fax:
Practice Address - Street 1:64 GUNDERMAN RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-8624
Practice Address - Country:US
Practice Address - Phone:607-339-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor