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NPI Code Detail

MEDICARE: MR. JASON SCOPPA D.C.

MEDICARE: MR. JASON SCOPPA 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
1111N00000XChiropractorCH60304341WA

General Provider Information

NPI Number : 1790037414
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JASON SCOPPA D.C.
Provider Business Mailing Address
First Line : 417 E PINE ST STE P
Second Line :
City : SEATTLE
State : WA
Zip : 98122-2378
Country : US
Telephone Number : 479-283-9493
Fax Number : 206-708-6472
Provider Business Practice Location Address
First Line : 417 E PINE ST STE P
Second Line :
City : SEATTLE
State : WA
Zip : 98122-2378
Country : US
Telephone Number : 479-283-9493
Fax Number : 206-708-6472
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2012
Last Update Date : 10/04/2012

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