MEDICARE: JASON B KASTER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH8759	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11-3716390	OTHER		TAX ID STATE OF FLORIDA
2	CH8759	OTHER	FL	LIC

General Provider Information

NPI Number	:	1003895079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON B KASTER DC

Provider Business Mailing Address
First Line	:	1791 BOY SCOUT DR STE 6
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2137
Country	:	US
Telephone Number	:	239-821-0417
Fax Number	:	239-936-2811

Provider Business Practice Location Address
First Line	:	1791 BOY SCOUT DR STE 6
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2137
Country	:	US
Telephone Number	:	239-332-2555
Fax Number	:	239-332-2556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	06/13/2023

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