Individual
DR. JASON C THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
550 W MAPLE ST, BARABOO, WI 53913-1166
(608) 355-4100
(608) 355-4107
Mailing address
550 W MAPLE ST, SUITE # 201, BARABOO, WI 53913-1166
(608) 355-4100
(608) 355-4107
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3855-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
350056012
RAILROAD MEDICARE
WI
05
—
38939100
—
WI
01
—
38996600
MEDICAID GROUP
WI
01
—
CB3715
RAILROAD MEDICARE GROUP
WI
Enumeration date
09/17/2006
Last updated
01/20/2016
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