MEDICARE: JASON MARK FREDERICK DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	15371	TX

General Provider Information

NPI Number	:	1386355386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON MARK FREDERICK DC

Provider Business Mailing Address
First Line	:	1386 SYDNEY DR
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-3263
Country	:	US
Telephone Number	:	303-981-4473
Fax Number	:

Provider Business Practice Location Address
First Line	:	3921 FABIAN WAY
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94303-4640
Country	:	US
Telephone Number	:	650-434-2466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2022
Last Update Date	:	02/02/2026

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