MEDICARE: DR. JASON REUBEN ROUNTREE 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	CHI-CHI-LIC-1242	MT
2	111N00000X	Chiropractor	DC010925	PA
3	111N00000X	Chiropractor	CH60339060	WA

General Provider Information

NPI Number	:	1528305810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON REUBEN ROUNTREE D.C.

Provider Business Mailing Address
First Line	:	1327 US HIGHWAY 2 W STE 2
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3413
Country	:	US
Telephone Number	:	406-314-6400
Fax Number	:	406-314-6401

Provider Business Practice Location Address
First Line	:	1327 US HIGHWAY 2 W STE 2
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3413
Country	:	US
Telephone Number	:	406-314-6400
Fax Number	:	406-314-6401

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

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	06/06/2019

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