MEDICARE: JASON CHONG 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	B890	NV

General Provider Information

NPI Number	:	1942414164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON CHONG D.C.

Provider Business Mailing Address
First Line	:	3441 W SAHARA AVE
Second Line	:	#C7
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-6061
Country	:	US
Telephone Number	:	702-220-9191
Fax Number	:	702-220-9292

Provider Business Practice Location Address
First Line	:	3441 W SAHARA AVE
Second Line	:	#C7
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-6061
Country	:	US
Telephone Number	:	702-220-9191
Fax Number	:	702-220-9292

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/08/2007

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Directions to “ JASON CHONG D.C.” Practice Location

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