MEDICARE: DR. JASON R FETTERMAN 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	007942L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	556387	OTHER	PA	HIGHMARK

General Provider Information

NPI Number	:	1467487363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON R FETTERMAN D.C.

Provider Business Mailing Address
First Line	:	56 INDUSTRIAL PARK ROAD, SUITE 2
Second Line	:
City	:	BROOKVILLE
State	:	PA
Zip	:	15825-1517
Country	:	US
Telephone Number	:	814-849-5834
Fax Number	:	814-849-5834

Provider Business Practice Location Address
First Line	:	56 INDUSTRIAL PARK ROAD, SUITE 2
Second Line	:
City	:	BROOKVILLE
State	:	PA
Zip	:	15825-1517
Country	:	US
Telephone Number	:	814-849-5834
Fax Number	:	814-849-5834

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	11/07/2014

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