Provider Demographics
NPI:1174987846
Name:ALLEN, JASON CARL (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:CARL
Last Name:ALLEN
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 1:900 HARVEY RD
Mailing Address - Street 2:STE 9B
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-3556
Mailing Address - Country:US
Mailing Address - Phone:979-704-3064
Mailing Address - Fax:
Practice Address - Street 1:900 HARVEY RD
Practice Address - Street 2:STE 9B
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-3556
Practice Address - Country:US
Practice Address - Phone:979-704-3064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13195111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor