Provider Demographics
NPI:1730325655
Name:MACK, JASON ALLEN (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ALLEN
Last Name:MACK
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 1:8854 GREENBACK LN STE 2
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-4084
Mailing Address - Country:US
Mailing Address - Phone:408-509-2200
Mailing Address - Fax:916-671-5661
Practice Address - Street 1:8854 GREENBACK LN STE 2
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4084
Practice Address - Country:US
Practice Address - Phone:408-509-2200
Practice Address - Fax:916-671-5661
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor