Provider Demographics
NPI:1992085690
Name:SCHWIETZ, JASON MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MICHAEL
Last Name:SCHWIETZ
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 1:1900 COUNTY ROAD D E STE 150
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5009
Mailing Address - Country:US
Mailing Address - Phone:651-249-1024
Mailing Address - Fax:
Practice Address - Street 1:1900 COUNTY ROAD D E STE 150
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5009
Practice Address - Country:US
Practice Address - Phone:651-249-1024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor