Provider Demographics
NPI:1538261425
Name:PACKER, JASON (PA-C, DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:PACKER
Suffix:
Gender:M
Credentials:PA-C, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N SUNRISE AVE
Mailing Address - Street 2:SUITE 1005
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2924
Mailing Address - Country:US
Mailing Address - Phone:916-782-1217
Mailing Address - Fax:916-782-7630
Practice Address - Street 1:151 N SUNRISE AVE
Practice Address - Street 2:SUITE 1005
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2924
Practice Address - Country:US
Practice Address - Phone:916-782-1217
Practice Address - Fax:916-782-7630
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29082111N00000X
CA23146363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0290820OtherBLUE SHIELD IDENTIF. NUMB
CADC0290820OtherBLUE SHIELD IDENTIF. NUMB