| Dr Jason P Deroche, DC | |
|
255 E Sonterra Blvd Ste 110, San Antonio, TX 78258-4076 | |
| (800) 404-6050 | |
| (866) 313-3397 |
| Full Name | Dr Jason P Deroche |
|---|---|
| Gender | Male |
| Speciality | Chiropractor - Rehabilitation |
| Location | 255 E Sonterra Blvd Ste 110, San Antonio, Texas |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295896512 | NPI | - | NPPES |
| 11031 | Other | TX | CHIROPRACTIC LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111NR0400X | Chiropractor - Rehabilitation | 11031 (Texas) | Primary |
| Provider Name | Airrosti Rehab Centers, Llc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1497989479 PECOS PAC ID: 3678814498 Enrollment ID: O20190725000429 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Jason P Deroche, DC Po Box 700688, San Antonio, TX 78270-0688 Ph: (210) 318-3007 | Dr Jason P Deroche, DC 255 E Sonterra Blvd Ste 110, San Antonio, TX 78258-4076 Ph: (800) 404-6050 |
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