Provider Demographics
NPI:1366729204
Name:MOONEY, JASON (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MOONEY
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 1:301 CENTER AVE S
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50169-9751
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 CENTER AVE S
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:IA
Practice Address - Zip Code:50169-9751
Practice Address - Country:US
Practice Address - Phone:712-790-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor