Healthcare Provider Details

I. General information

NPI: 1083620405
Provider Name (Legal Business Name): JASON ERNEST CHASTAIN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 MAIN ST
KIMBALL TN
37347-5551
US

IV. Provider business mailing address

PO BOX 910
JASPER TN
37347-0910
US

V. Phone/Fax

Practice location:
  • Phone: 423-942-2222
  • Fax: 423-942-0200
Mailing address:
  • Phone: 423-942-2222
  • Fax: 423-942-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number1747
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: