MEDICARE: DR. JAKE HUNTER DOSTER D.C.

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	2630	TN

General Provider Information

NPI Number	:	1962754325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAKE HUNTER DOSTER D.C.

Provider Business Mailing Address
First Line	:	3566 HIGHWAY 45 N
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-7890
Country	:	US
Telephone Number	:	731-664-8000
Fax Number	:	731-664-8100

Provider Business Practice Location Address
First Line	:	3566 HIGHWAY 45 N
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-7890
Country	:	US
Telephone Number	:	731-664-8000
Fax Number	:	731-664-8100

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

Provider Enumeration Date	:	10/10/2012
Last Update Date	:	10/10/2012

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