=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336335330
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KASTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2007
-----------------------------------------------------
Last Update Date | 06/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1791 BOY SCOUT DR STE 6
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907-2137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-821-0417
-----------------------------------------------------
Fax | 239-332-2556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1791 BOY SCOUT DR STE 6
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907-2137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-821-0417
-----------------------------------------------------
Fax | 239-332-2556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. JASON BOYD KASTER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 239-821-0417
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------