MEDICARE: JASON W INGHAM DC SC

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	111NS0005X	Sports Physician Chiropractor	038008978	IL

General Provider Information

NPI Number	:	1992982664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASON W INGHAM DC SC

Provider Business Mailing Address
First Line	:	2828 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5775
Country	:	US
Telephone Number	:	773-868-0347
Fax Number	:	773-868-0401

Provider Business Practice Location Address
First Line	:	2828 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5775
Country	:	US
Telephone Number	:	773-868-0347
Fax Number	:	773-868-0401

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JASON WAYNE INGHAM
Credential	:	D.C.
Telephone Number	:	773-868-0347

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	09/11/2023

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