MEDICARE: DR. JASON FREDIN 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	3909	OK
2	111N00000X	Chiropractor	06962	IA

General Provider Information

NPI Number	:	1427222132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON FREDIN D.C.

Provider Business Mailing Address
First Line	:	3623 1/2 DOUGLAS AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50310-5366
Country	:	US
Telephone Number	:	515-279-0930
Fax Number	:

Provider Business Practice Location Address
First Line	:	3623 1/2 DOUGLAS AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50310-5366
Country	:	US
Telephone Number	:	515-279-0930
Fax Number	:

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

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	10/20/2020

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