MEDICARE: DR. JASON R TALLEY DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038-009072	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	350054835	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4400069	OTHER	IL	UNITED HEALTH CARE
2	442971	OTHER	IL	HEALTHLINK
4	6026195	OTHER	IL	BLUE CROSS BLUE SHIELD
5	U81510	OTHER	IL	MERCY
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144224734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON R TALLEY DC

Provider Business Mailing Address
First Line	:	3100 MARYVILLE RD
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-5185
Country	:	US
Telephone Number	:	618-451-2874
Fax Number	:	618-451-2858

Provider Business Practice Location Address
First Line	:	2025 EDISON AVE
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-4514
Country	:	US
Telephone Number	:	618-451-2874
Fax Number	:	618-451-2858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	12/04/2019

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Directions to “ DR. JASON R TALLEY DC” Practice Location

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