MEDICARE: DR. JASON O JAEGER 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	B00949	NV
2	208100000X	Physical Medicine & Rehabilitation Physician	B00949	NV
3	111NN1001X	Nutrition Chiropractor	B00949	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39031	OTHER	NV	MEDICARE ID PART B

General Provider Information

NPI Number	:	1326008079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON O JAEGER D.C.

Provider Business Mailing Address
First Line	:	PO BOX 401805
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89140-1805
Country	:	US
Telephone Number	:	702-396-4993
Fax Number	:	702-636-4990

Provider Business Practice Location Address
First Line	:	6592 N DECATUR BLVD
Second Line	:	SUITE 115
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-1037
Country	:	US
Telephone Number	:	702-396-4993
Fax Number	:	702-636-4990

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

Provider Enumeration Date	:	03/26/2006
Last Update Date	:	09/17/2013

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