Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 8350 | AZ |
N | 111NN1001X | Nutrition | 8350 | AZ |
NPI | 1477971711 |
---|---|
Provider Name | Dr. Jason Derek Mcdonald |
First Address | Queen Creek, AZ 85142-6788 |
Second Address | Queen Creek, AZ 85142-6788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2014 |
Last Update Date | 03/06/2020 |