Provider Demographics
NPI:1992579395
Name:LOC, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:LOC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-3419
Mailing Address - Country:US
Mailing Address - Phone:626-389-7665
Mailing Address - Fax:
Practice Address - Street 1:5317 N FIGUEROA ST STE 11
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-4066
Practice Address - Country:US
Practice Address - Phone:213-671-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36780111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor