Provider Demographics
NPI:1366741902
Name:THOMPSON, JASON AMBROSE (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:AMBROSE
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 N LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-4268
Mailing Address - Country:US
Mailing Address - Phone:847-223-3158
Mailing Address - Fax:888-481-4758
Practice Address - Street 1:15 COMMERCE DR STE 108
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-7807
Practice Address - Country:US
Practice Address - Phone:847-223-3158
Practice Address - Fax:888-481-4758
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor