MEDICARE: JASON C KINDSCHI DC

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	4099	WI

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

General Provider Information

NPI Number	:	1528050325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON C KINDSCHI DC

Provider Business Mailing Address
First Line	:	204 W COTTAGE GROVE RD
Second Line	:
City	:	COTTAGE GROVE
State	:	WI
Zip	:	53527-9211
Country	:	US
Telephone Number	:	608-839-1172
Fax Number	:	608-839-1174

Provider Business Practice Location Address
First Line	:	204 W COTTAGE GROVE RD
Second Line	:
City	:	COTTAGE GROVE
State	:	WI
Zip	:	53527-9211
Country	:	US
Telephone Number	:	608-839-1172
Fax Number	:	608-839-1174

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	06/27/2008

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Directions to “ JASON C KINDSCHI DC” Practice Location

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