Provider Demographics
NPI:1962552463
Name:SMITH, JASON M (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:M
Last Name:SMITH
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:PO BOX 1001
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-1001
Mailing Address - Country:US
Mailing Address - Phone:337-457-1376
Mailing Address - Fax:337-457-1379
Practice Address - Street 1:200 N 2ND ST
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3338
Practice Address - Country:US
Practice Address - Phone:337-457-1376
Practice Address - Fax:337-457-1379
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H300CN56Medicare PIN