Provider Demographics
NPI:1366502411
Name:HOOVER, JASON R (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:R
Last Name:HOOVER
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 1:130 JOHN FRANK WARD BLVD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3207
Mailing Address - Country:US
Mailing Address - Phone:770-957-4165
Mailing Address - Fax:770-957-2003
Practice Address - Street 1:130 JOHN FRANK WARD BLVD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3207
Practice Address - Country:US
Practice Address - Phone:770-957-4165
Practice Address - Fax:770-957-2003
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00156630OtherRAILROAD MEDICARE
GAU98476Medicare UPIN
GAP00156630OtherRAILROAD MEDICARE