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General NPI Number Information
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NPI Number | 1386355386
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Entity Type | Individual
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Provider Name | JASON MARK FREDERICK DC
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Gender | Male
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Dates
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Enumeration Date | 12/09/2022
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 3921 FABIAN WAY
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City | PALO ALTO
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State | CA
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Zip | 94303-4640
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Country | US
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Telephone | 650-434-2466
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Fax |
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Provider Business Mailing Address
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Address Line | 1386 SYDNEY DR
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City | SUNNYVALE
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State | CA
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Zip | 94087-3263
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Country | US
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Telephone | 303-981-4473
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 15371
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License Number State | TX
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