Healthcare Provider Details

I. General information

NPI: 1871435651
Provider Name (Legal Business Name): MASON JABERO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E LONG LAKE RD STE 101
TROY MI
48085-4974
US

IV. Provider business mailing address

1120 E LONG LAKE RD STE 101
TROY MI
48085-4974
US

V. Phone/Fax

Practice location:
  • Phone: 810-964-4969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301401724
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: