Healthcare Provider Details

I. General information

NPI: 1053397232
Provider Name (Legal Business Name): DR. JASON GUTCHES
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977 ROYAL AVE
MEDFORD OR
97504-6140
US

IV. Provider business mailing address

1024 MEGAN LN
PHOENIX OR
97535-6630
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-8331
  • Fax:
Mailing address:
  • Phone: 541-324-8929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3540
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: