Provider Demographics
NPI:1760460158
Name:WALP, JASON VAUGHN (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:VAUGHN
Last Name:WALP
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 1:8913 CLEMENT AVE
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2603
Mailing Address - Country:US
Mailing Address - Phone:410-882-6500
Mailing Address - Fax:410-882-6640
Practice Address - Street 1:8913 CLEMENT AVE
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2603
Practice Address - Country:US
Practice Address - Phone:410-882-6500
Practice Address - Fax:410-882-6640
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor