Provider Demographics
NPI:1174587877
Name:EBELSHEISER, JASON DANIEL (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:DANIEL
Last Name:EBELSHEISER
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 1:120 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-2812
Mailing Address - Country:US
Mailing Address - Phone:641-676-1400
Mailing Address - Fax:641-676-1401
Practice Address - Street 1:120 N 1ST ST
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-2812
Practice Address - Country:US
Practice Address - Phone:641-676-1400
Practice Address - Fax:641-676-1401
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA38214OtherBLUE CROSS BLUE SHIELD ID
IA0479006Medicaid
IA246032OtherMIDLANDS CHOICE ID
IA0452748Medicaid
IA246032OtherMIDLANDS CHOICE ID
IAI14751Medicare ID - Type UnspecifiedINDIVIDUAL ID
IA0452748Medicaid