MEDICARE: DR. JASON MCCOY SLADE D.C.

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	12482	TX

General Provider Information

NPI Number	:	1184758062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON MCCOY SLADE D.C.

Provider Business Mailing Address
First Line	:	5656 WILLS CREEK LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-7626
Country	:	US
Telephone Number	:	951-805-5473
Fax Number	:

Provider Business Practice Location Address
First Line	:	5656 WILLS CREEK LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-7626
Country	:	US
Telephone Number	:	951-805-5473
Fax Number	:

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	01/21/2014

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