Individual
DR. JASON RYAN WHITACRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1200 LOCUST ST, MURPHYSBORO, IL 62966-2121
(618) 684-3344
(618) 684-2216
Mailing address
7 SUBURBAN DR, MURPHYSBORO, IL 62966-2938
(618) 684-3344
(618) 684-2216
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003932012
BCBS
IL
Enumeration date
07/17/2006
Last updated
07/08/2007
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