Healthcare Provider Details

I. General information

NPI: 1750590659
Provider Name (Legal Business Name): JASON ALAN SHUMARD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7094 MIRAMAR RD STE 109
SAN DIEGO CA
92121-2311
US

IV. Provider business mailing address

7094 MIRAMAR RD STE 109
SAN DIEGO CA
92121-2311
US

V. Phone/Fax

Practice location:
  • Phone: 858-564-7081
  • Fax:
Mailing address:
  • Phone: 858-564-7081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC29400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: