Provider Demographics
NPI:1114051851
Name:MEHESS, JASON (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MEHESS
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 1:6700 167TH ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2859
Mailing Address - Country:US
Mailing Address - Phone:708-429-6061
Mailing Address - Fax:708-429-6092
Practice Address - Street 1:6700 167TH ST
Practice Address - Street 2:SUITE #2
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2859
Practice Address - Country:US
Practice Address - Phone:708-429-6061
Practice Address - Fax:708-429-6092
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633192OtherBLUE CROSS BLUE SHIELD
IL01633192OtherBLUE CROSS BLUE SHIELD
ILK10616Medicare ID - Type Unspecified