Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | B00949 | NV |
N | 111NN1001X | Nutrition | B00949 | NV |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | B00949 | NV |
NPI | 1326008079 |
---|---|
Provider Name | Dr. Jason O Jaeger |
First Address | Las Vegas, NV 89140-1805 |
Second Address | Las Vegas, NV 89131-1037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2006 |
Last Update Date | 17/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
39031 | MEDICARE ID PART B (01) | NV |
V04825 | (02) | NV |