Provider Demographics
NPI:1366794893
Name:KROESE, JASON L (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:L
Last Name:KROESE
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 1:535 16TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-4261
Mailing Address - Country:US
Mailing Address - Phone:303-371-5280
Mailing Address - Fax:
Practice Address - Street 1:535 16TH ST STE 200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-4261
Practice Address - Country:US
Practice Address - Phone:303-371-5280
Practice Address - Fax:303-623-0446
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor