Provider Demographics
NPI:1699941260
Name:STONE, JASON ANDREW (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ANDREW
Last Name:STONE
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 1:1815 OLD TROLLEY RD
Mailing Address - Street 2:UNIT 109
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8284
Mailing Address - Country:US
Mailing Address - Phone:843-875-6990
Mailing Address - Fax:843-875-0992
Practice Address - Street 1:1815 TROLLEY RD
Practice Address - Street 2:UNIT 109
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8284
Practice Address - Country:US
Practice Address - Phone:843-875-6990
Practice Address - Fax:843-875-0992
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2420Medicaid
SCCH2420Medicaid