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General NPI Number Information
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NPI Number | 1700916707
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Entity Type | Individual
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Provider Name | JASON BRIAN MASTERS D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3005 W LAKE MARY BLVD STE 101
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City | LAKE MARY
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State | FL
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Zip | 32746-6060
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Country | US
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Telephone | 407-330-7577
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Fax |
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Provider Business Mailing Address
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Address Line | 1824 WINGFIELD DR
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City | LONGWOOD
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State | FL
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Zip | 32779-2706
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Country | US
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Telephone | 407-788-0769
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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 | CH 4972
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License Number State | FL
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