Provider Demographics
NPI:1972783876
Name:GENER, JASON LOPEZ (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:LOPEZ
Last Name:GENER
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 1:12100 HIGHWAY 41 N
Mailing Address - Street 2:SUITE 4
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-7032
Mailing Address - Country:US
Mailing Address - Phone:812-867-1400
Mailing Address - Fax:
Practice Address - Street 1:12100 HIGHWAY 41 N
Practice Address - Street 2:SUITE 4
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-7032
Practice Address - Country:US
Practice Address - Phone:812-867-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002361A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor