Individual
DR. JASON R TALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
2025 EDISON AVE, GRANITE CITY, IL 62040-4514
(618) 451-2874
(618) 451-2858
Mailing address
3100 MARYVILLE RD, GRANITE CITY, IL 62040-5185
(618) 451-2874
(618) 451-2858
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038-009072
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038009072
—
IL
01
—
350054835
RAILROAD MEDICARE
IL
01
—
4400069
UNITED HEALTH CARE
IL
01
—
442971
HEALTHLINK
IL
01
—
6026195
BLUE CROSS BLUE SHIELD
IL
01
—
U81510
MERCY
IL
Enumeration date
06/10/2005
Last updated
12/04/2019
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