Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH8759 | FL |
NPI | 1003895079 |
---|---|
Provider Name | Jason B Kaster |
First Address | Fort Myers, FL 33907 |
Second Address | Fort Myers, FL 33907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 25/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11-3716390 | TAX ID STATE OF FLORIDA (01) | |
CH8759 | LIC (01) | FL |
U92168 | (02) |