Provider Demographics
NPI:1699878892
Name:PUFFETT, JASON CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:CHARLES
Last Name:PUFFETT
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 1:201 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-2824
Mailing Address - Country:US
Mailing Address - Phone:319-334-2324
Mailing Address - Fax:319-334-2494
Practice Address - Street 1:201 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-2824
Practice Address - Country:US
Practice Address - Phone:319-334-2324
Practice Address - Fax:319-334-2494
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06461111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1255174Medicaid
IA45048OtherBLUE CROSS BLUE SHIELD
IA45048OtherBLUE CROSS BLUE SHIELD
IAI15571Medicare PIN