Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4328 | OH |
N | 111NP0017X | Pediatric Chiropractor | 4328 | OH |
N | 111NS0005X | Chiropractic Sports Physician | 4328 | OH |
N | 111NX0100X | Occupational Health | 4328 | OH |
NPI | 1467882639 |
---|---|
Provider Name | Dr. Jason Edward Feltz |
First Address | Grove City, OH 43123-2201 |
Second Address | Grove City, OH 43123-2201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2013 |
Last Update Date | 04/03/2015 |