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NPI Code Detail

MEDICARE: DR. JASON BOLLENBAUGH D.C.

MEDICARE: DR. JASON BOLLENBAUGH 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
1111N00000XChiropractor038-009505IL
2111N00000XChiropractor2614TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1210868001OTHERILMEDICARE PTAN - INDIVIDUAL
5210868OTHERILMEDICARE GROUP - MCC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2681087OTHERILUHC#
37521142OTHERILBC/BS GROUP MCC
4620543OTHERILHEALTHLINK
637-1361254OTHERILTAX ID - MCC
7601151600OTHERILUS DEPT OF LABOR

General Provider Information

NPI Number : 1245237189
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON BOLLENBAUGH D.C.
Provider Business Mailing Address
First Line : 2191 HILLSBORO RD
Second Line : SUITE A
City : FRANKLIN
State : TN
Zip : 37069-6223
Country : US
Telephone Number : 618-420-0409
Fax Number : 615-465-6682
Provider Business Practice Location Address
First Line : 2191 HILLSBORO RD
Second Line : SUITE A
City : FRANKLIN
State : TN
Zip : 37069-6223
Country : US
Telephone Number : 618-420-0409
Fax Number : 615-465-6682
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 06/12/2014

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