Healthcare Provider Details

I. General information

NPI: 1417673666
Provider Name (Legal Business Name): JASON ALEX RAMOS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 CENTRAL PKWY SW STE N
DECATUR AL
35601-6825
US

IV. Provider business mailing address

1711 CENTRAL PKWY SW STE N
DECATUR AL
35601-6825
US

V. Phone/Fax

Practice location:
  • Phone: 256-353-7576
  • Fax:
Mailing address:
  • Phone: 256-353-7576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2759
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number2759
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number2759
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: