Provider Demographics
NPI:1144319708
Name:WATSON, JASON (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:WATSON
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 1:1521 E BOISE AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5064
Mailing Address - Country:US
Mailing Address - Phone:208-345-3320
Mailing Address - Fax:208-345-6330
Practice Address - Street 1:1521 E BOISE AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-5064
Practice Address - Country:US
Practice Address - Phone:208-345-3320
Practice Address - Fax:208-345-6330
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor