MEDICARE: DR. JASON ALLEN NUTCHE 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	111NT0100X	Thermography Chiropractor	038-010447	IL
2	111N00000X	Chiropractor	DC009649	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01132008	OTHER	IL	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1346277175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON ALLEN NUTCHE D.C.

Provider Business Mailing Address
First Line	:	1608 WALNUT ST
Second Line	:	SUITE 601
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-5457
Country	:	US
Telephone Number	:	215-546-1010
Fax Number	:	215-546-1005

Provider Business Practice Location Address
First Line	:	1608 WALNUT ST
Second Line	:	SUITE 601
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-5457
Country	:	US
Telephone Number	:	215-546-1010
Fax Number	:	215-546-1005

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	10/02/2013

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