Individual
DR. JASON WAYNE INGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC, CCSP
Contact information
Practice address
2828 N CLARK ST, CHICAGO, IL 60657-5775
(773) 868-0347
(773) 868-0401
Mailing address
2828 N CLARK ST, CHICAGO, IL 60657-5775
(773) 868-0347
(773) 868-0401
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038008978
IL
111NS0005X
Sports Physician Chiropractor
038-008978
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01626851
BLUE CROSS BLUE SHEILD
IL
Enumeration date
09/25/2006
Last updated
07/12/2023
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